Guarantee Letter Form

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The guarantee letter is ONLY FOR THE STUDENT HIMSELF/HERSELF to get medical treatment at a government hospital or clinic.

Please take note

- For SASMEC@IIUM : the student may show the matric card, the GL not required

- For Government Hospital : you may use this guarantee letter
- NOT APPLICABLE for Private Hospital

Please fill in the form and we will email the letter to you in PDF format. It will be ready within THREE (3) WORKING DAYS after the submission date. For any further inquiries, please do not hesitate to email us nurain@iium.edu.my.

Thank you.

*updated: 16/11/2023

Email *

Full Name (as per IC/Passport) *

NIRC/Passport Number (ie : 123456-01-4444) *

Please ensure that your NIRC/Passport number is correct to avoid any error in guarantee letter

Matric No. *

Citizenship *

Hospital Name *

Hospital Address *

Contact Number *

Department *

Surgery

Orthopaedics

Obstetrics & Gynaecology

Radiology

Family Medicine

Internal Medicine

Psychiatry

Otolaryngology-Head & Neck Surgery

Ophthalmology

Anaesthesiology

Public Health

MMDSc

PhD-MDSc

Required

Reason application *

Method of Collection *

self pickup at Postgraduate Office, KOM

Submit

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