CENTRE FOR UNIVERSITY – INDUSTRY COLLABORATION (CUIC)

UNIVERSITI UTARA MALAYSIA

ORGANISATION NOMINATION FORM
PRACTICUM SESSION : A 202 (INTERNSHIP PLACEMENT)
PROGRAMME : DEGREE IN BACHELOR OF LAW WITH HONOURS

Name : NUR FARHANA BINTI MOHD RADZUAN Matric Number : 264742

Home Address : BLOK A-3-3 KEMENSAH VILLA JALAN MELATI INDAH 1 SAUJANA MELAWATI 53100 KL Current CGPA : 3.07
Majoring (if any) : ___________________________________
Tel. Number Mobile : 0166741070 Email Address : radzuan.farhana@gmail.com
Home : -
Parents/Guardian : MOHD RADZUAN BIN ABD MANAF

Option 1 Option 2 Option 3

Organisation’s ZAID IBRAHIM & CO (belum contact)
Name

Address LEVEL 19 MENARA MILENIUM, JALAN

DAMANLELA, DAMANSARA TOWN CENTRE,
50490, FEDERAL TERRITORY OF KUALA
LUMPUR
Type of Business LAW FIRM
Officer In-Charge PUAN BASYIRAH ANUAR
Position STRATEGIC MARKETING MANAGER
Tel. Number 03-2087 9999
Fax. Number 03-2094 4888
Email Address basyirah.anuar@zaidibrahim.com.my

Date : 27/6/2021 Student’s Signature : FARHANA Name of CUIC Person In-Charge : PUAN NOR HAYATI BINTI MAAROP

Note :
1. CUIC will process the application to the above organisation by priority.
2. Only completed form will be processed.
3. Changes of nomination are not allowed after getting offer letter from organisation.
4. Kindly contact CUIC at 04-928 4917/4922/4924/4927/4928/4929/4930 for more information.
5. Please update your Resume (Portal) before submit this form.