Online Registration
Universal Business Academy
14A, Jalan Harimau Tarum,
Taman Abad, 80250,
Johor Bahru, Johor.
Tel: +607-333 5111
Whatsapp: +6013-743 8181
Web: www.universalbusinessacademy.com
AGENT CODE
Date Of Registration *
MM
/
DD
/
YYYY
Title *
First(given) name(s) *
Last name (family name/surname) *
Date Of Birth ( ex: 15 Jan 1990) *
Gender *
Required
First Language *
Nationality *
Identification Document Number ( Passport No ) *
Identification Document Expiry Date *
MM
/
DD
/
YYYY
Issuing Authority *
Address *
Town or City *
Country or State *
Zip / Postal Code *
Country *
Required
Telephone *
Mobile number *
Email *
Do you have a permanent disability, such as a visual, hearing or specific learning difficulty, which requires special arrangements (for example, modified material, extra time, use of technology, etc.)?: *
If yes, please brief details
Highest Education, please provide the full name of the program *
Scanned Highest Qualification Certificate/SPM/Diploma/Degree *
Required
Scanned IC(Front and Back) *
Required
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