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  • This online application has personal details, education details and declarations.
  • All details must be completed in this form.
  • Please do not submit more than one application.
  • For further information please contact: (6)06-6014332 (Midas Seremban) or email to: inquiry@midas.edu.my
  PERSONAL DETAILS
   
  Name  
  Address  
  Town/ City  
  State
    Postcode  
  Country  
   
  Diploma Program
  MLVK Program
   
  Marital Status
    Date Of Birth  (dd-month-yyyy)  
    Passport No.  
    E-mail Address  
  Gender
  Phone No.
  Nationality  
   
  TERTIARY EDUCATION DETAILS
    Name and Location of   Date Attended   Examination   Date
No
   School / College   From (dd/mm/yyyy)   To (dd/mm/yyyy)   Certificate/Diploma   Received (dd/mm/yyyy)
           
1
          
2
          
3
          
4
          
5
          
DECLARATION BY APPLICANT
  PLEASE READ THE FOLLOWING DECLARATION AND INDICATE ACCEPTANCE OF THE   CONDITIONS:

      I confirm that, to the best of my knowledge, the information given on this form is correct and understanding that all   fees paid are NOT REFUNDABLE
  Name  
  Date  (dd/mm/yyyy) :  
   
DECLARATION BY PARENT / GUARDIAN
      I hereby undertake to guarantee the good conduct of the above applicant and agree to pay all the fee due on   his/her behalf to MIDAS in accordance with its policies. I also agree that all the fees paid are NOT REFUNDABLE .
  Name  
  Date  (dd/mm/yyyy) :  
   
 
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