UTHM Introducer application form

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This form will be used for screening purposes. All data that being provided will be treated as confidential. Once the application is approved by Centre for Graduate Studies, agreement document with term and condition will be submitted via email and introducer need to pay RM50 for agreement stamping fee.

Email *

Name *

Passport Number/IC *

Matric Number *

Mobile phone number *

Address *

Postcode *

Country *

Bank name *

Bank account number *

I hereby declare that the information provided is true and correct. I agree to pay RM 50 for processing and agreement stamping fee if Centre for Graduate Studies UTHM approved me to be an Introducer *

Agree

A copy of your responses will be emailed to the address you provided.

Submit

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