SECTION 11 Declaration

Declaration by Applicant
• I warrant that the information on this form, or provided in support of my application, is correct and complete.

Application form for

• I acknowledge that the provision of incorrect information or the act of withholding relevant information relating to my
application, including academic transcript(s), might invalidate my application and that BERJAYA University College may
withdraw an offer of a place or cancel my enrolment in consequence.

Malaysian students
• I further agree to abide by BERJAYA University College policies, rules and regulations at all times.
• I accept that BERJAYA University College reserves the right to revise the current fees without prior notice.
• I hereby agree to give consent to BERJAYA University College to release my academic reports/results and attendance
reports to my parents/guardian/sponsors as and when necessary. Signature of Applicant
• I have also read and understood the Tuition Fees Refund Policy of BERJAYA University College as stated in the Fees Guidelines
Schedule.
• I undertake to ensure that all fees are paid by the specified due dates, and failing which I agree to pay any late payment 1. Please complete this form clearly in pen and use BLOCK LETTERS. 4. It is your responsibility to advise BERJAYA University College regarding
and/or administrative charges incurred after the due dates.
2. Please enclose the following with this application: any change of address.
• I understand that I may be barred from classes, examinations and the use of facilities if I fail to pay all fees. Please attach
• Supporting documents must be certified by a recognized 5. Please complete the “ACCOMMODATION FORM” if you require
• I hereby give permission to BERJAYA University College for the use of photographs, images, and videos in publicity dd/mm/yy campus appointed residence.
non-returnable
and promotional materials and to release relevant information to our Career Centre, Alumni, Collaborative Partners and authority. This application WILL NOT be processed unless full passport-sized
any Government bodies or agencies as required. documentation is attached. 6. This application is the property of BERJAYA University College. colour photograph
• By providing my personal data i consent to receiving information on courses, programmes and events that may benefit • Two (2) passport-size colour photographs. Supporting documents WILL NOT be returned.
me.
3. An enrollment fee (non refundable) is payable on submission of this
form. Bank draft is to be made payable to “BERJAYA HIGHER
EDUCATION SDN BHD”. Cash is only payable at the Payment
Counter.
Declaration by Parent/Guardian (if applicable)

I hereby agree to pay all fees due on the dates stipulated by BERJAYA University
Please send your application to:
College. I also understand and agree to the conditions as stated in this application
form. SALES AND MARKETING OFFICE
BERJAYA UNIVERSITY COLLEGE
Name (as in NRIC / Passport) | LEVEL 11 WEST, BERJAYA TIMES SQUARE,
Signature of Parent/Guardian NO 1 JALAN IMBI, 55100 KUALA LUMPUR, MALAYSIA
Relationship |
T 603 2687 7000 F 603 2687 7001 W www.berjaya.edu.my
 Father  Mother

 Guardian
dd/mm/yy SECTION 1 Programme Preference
Occupation/Position |
Programme |
Company |
Intake | Year |  Full-time  Part-time
Contact Address |

Postcode | Country | SECTION 2 Student’s Personal Details

Telephone (H) | (O) |
Title (eg Mr / Ms / Mdm) |
Mobile | Facsimile |
Family Name / Surname |

Given Name/s |
FOR OFFICE USE ONLY
NRIC No | Nationality |

Sales and Marketing Office / Head of School Authorised by: Race Gender Religion

 Conditional Offer  Full Offer  Reject Name |  Malay  Male  Muslim  Taoism

 Chinese  Female  Christianity  Hinduism

Conditions/Remarks | Department |
 Indian  Buddhism
Date |  Others (Please specify) |  Others (Please specify) |

Permanent Address |
Head of Programme / Head of School Authorised by:

 Review of Conditional Offer  Condition(s) Fulfilled  Reject Name |

Postcode | State |
Remarks | Department |
Telephone | Mobile | Facsimile |
Date |
Email |

Agent’s Company Stamp: Authorised by: Correspondence Address | (if different from Permanent Address)

Name |

Department |
Postcode | State | Country |
Date |

Telephone | Mobile | Facsimile |

AR13/17 | DKU007(W) | Formerly known as BERJAYA University College of Hospitality AR13/17 | DKU007(W) | Formerly known as BERJAYA University College of Hospitality
 SECTION 3 Emergency Contact SECTION 7 Financial Resources/Sponsorship

 Self / Parents / Guardian  External Sponsor (please complete below)

Contact Person 1 | Contact Person 2 |
For External:
Relationship | Relationship |
Name of Sponsor / Company |

Mobile | Mobile |
Relationship (if applicable) |

Email | Email |
Contact Person |

Address |
Position |

Postcode | State | Country |

Telephone | Mobile | Facsimile |

Telephone | Facsimile | Please provide documentation to support your sponsorship either by a government or private agency.

SECTION 4 Academic Qualification SECTION 8 Medical History

Please provide the following details:  Actual Results  Forecast Results Do you have any disability, impairment or long term medical condition?

 SPM  Yes

 UEC  No

 STPM
If yes, please specify |
 Others (please specify) |

School/Institution |

State | Year of Completion |

Credit transfer required?  Yes  No

SECTION 9 Important Checklist
If yes, please complete the ‘Application for Credit Transfer’

 Enrolment fee of RM550

SECTION 5 English Language Achievement  Certified true copy of National Registration Identity Card (NRIC)

 Two (2) passport-sized coloured photographs

 Certified true copies of all relevant examination results/transcripts

All programmes have English Language proficiency requirements. Please provide proof of your English Language proficiency (if any)
 Certified true copy of School Leaving Certificate (if applicable)
 TOEFL _____________  SPM English _____________  Cambridge English: _____________
Advanced (CAE) / Proficiency (CPE)  Proof of English Language proficiency (if applicable)
 IELTS _____________  UEC English _____________
 Certified true copies of syllabi for credit transfer application (if applicable)
 MUET (Malaysia University English Test) _____________  ’O’ Level English (1119) _____________  Pearson Test of English Academic(PTE) _____________
 CV or supplementary documents (if applicable)
 Others (please state) |
 Financial sponsorship documentary evidence (if applicable)

Name of Institution |
SECTION 10 Conditions of Enrollment
Year |
• A student is considered fully enrolled upon registration and • All claims for refund of any monies (and/or any other payments)
payment of all fees and deposits as set out in the Fee Schedule. shall be made within one (1) year from the date the student
If you do not have proof of any English Language proficiency, you will be required to sit for the English Placement Test (EPT) of BERJAYA University An administrative charge of RM200.00 will be imposed for all
• Failure to pay fees may result in the student being barred from withdrawals. withdraws from BERJAYA University College, failing which the
College. If you do not meet the minimum requirement of the EPT, you will be required to register for the Intensive English Programme (IVEP). classes, examinations and the use of facilities. amount thereof shall accrue in favour of BERJAYA University
Exception to the rule - A student who withdraws due to medical College and henceforth the right to claim shall automatically cease.
• The refund of deposits or any other fees due to the student will reasons (supported by a medical report from a hospital) will not be BERJAYA University College shall be entitled to transfer the said
be processed. This may take up to eight (8) weeks to pocess charged the administrative charge of RM200.00 monies into a separate account/fund and apply the same for any
from the date of receipt by Finance Office of Withdrawal. • Payments are to be made by bank draft or telegraphic transfer to other purpose deemed fit by BERJAYA University College.
• All fees paid are not refundable or transferable except where a the following account.
• Any course transfer must be made in writing within two (2)
SECTION 6 Employment History (if applicable) written notice is recieved by the University College. weeks of the commencement of the trimester. Transfer of tuition
The amount of tuition fees refundable is subject to the following: fees is at the discretion of BERJAYA University College. Full fees
Bank name : Maybank Berhad are only transferable if the application for transfer is received
Situations Refund Decision Account name: Berjaya Higher Education Sdn. Bhd. before the commencement of the trimester.
1. If a student withdraws from the 100% of the semester fees are Account number: 5-14084-51052-8
• BERJAYA University College reserves the right to use a student’s
Employment Type:  Full Time  Part Time  Contract programme before the refundable except enrolment Swift code: MBBEMYKL
personal information in any publicity and/or promotion exercise of
commencement of the fees. Branch : Bukit Bintang BERJAYA University College. The scope of usage of this
trimester. information may include the publishing of good examination
Name of Employer | 2. If the student withdraws from Only 50% of the tuition fees • All general fees are non-refundable. results, the award of a price or scholarship, any achievement(s),
the programme between academic or otherwise, and the granting access for his/her
and the librabry deposit are • All refunds of fees, deposits and/or any other payments, shall be
one(1) to four(4) weeks of information by BERJAYA University College Alumni Association.
refundable. free of interest and shall be subject to the right of set-off by
Current Position/Occupation | commencement of the BERJAYA University College against any fee and/or any other
trimester. payments due and owing to BERJAYA University College.
3. If a student withdraws from Only the library deposit will be
No of Years Employed | refunded. • In the event a student is expelled from BERJAYA University
the programme after four(4) College due to disciplinary/academic misconduct, there shall be no
weeks of the commencement refund of fees paid except refundable deposits.
of the trimester.
Please provide details of any employment experience that may be RELEVANT to the programme application with supporting documents eg. CV or
employment letters. Please use additional pages if the space above is insufficient.

AR13/17 | DKU007(W) | Formerly known as BERJAYA University College of Hospitality AR13/17 | DKU007(W) | Formerly known as BERJAYA University College of Hospitality