KDU UC Penang Student Application Form (International)
(Please use BLOCK letters)
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SECTION A: Personal Information
Name (as in Passport) *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
Nationality *
Your answer
Religion *
Your answer
Place of birth *
Your answer
Marital Status *
Passport no *
Your answer
Place of issue *
Your answer
Passport issue date *
MM
/
DD
/
YYYY
Passport expiry date
MM
/
DD
/
YYYY
Passport endorsement
(Applicable to China students applying for Single Entry Visa into Malaysia)
Status of application *
Sponsorship
Permanent address in home country *
Your answer
City *
Your answer
State *
Your answer
Country *
Your answer
Post code *
Your answer
Telephone no
Your answer
Mobile no *
Your answer
E-mail address *
Your answer
Billing address
(if different from above)
Your answer
City
Your answer
State
Your answer
Country
Your answer
Post code
Your answer
Name of parent / guardian *
Your answer
Relationship *
Your answer
Occupation *
Your answer
Fax no
Your answer
House telephone no
Your answer
Office telephone no
Your answer
Mobile phone no *
Your answer
E-mail address
Your answer
Address in Malaysia
(if any)
Your answer
City
Your answer
State
Your answer
Country
Your answer
Post code
Your answer
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