FACULTY OF COMPUTER SCIENCE AND INFORMATION TECHNOLOGY

Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak

Industrial Training Documents Submission Form

DECLARATION BY STUDENT

I, hereby declare that the information provided in all documents prepared and submitted to the university
is valid and genuine to the best of my knowledge and belief. I have ensured as a custodian of the
confidentiality of all information, data, documents, and any other records that are within my knowledge
while undergoing my industrial training, I did not participate in any ways to disclose, prepare, print, publish,
distribute or share any such matter with any party whether electronically, physically or in any other manner
without permission from the company.

STUDENT NAME:
MATRIC NO:
DATE:
SIGNATURE OF STUDENT

DECLARATION BY COMPANY SUPERVISOR

I, hereby verify that the information contained in all documents prepared and submitted by the student is
genuine and doesn’t contain any confidential information or classified data that might in a way, or another
abuse the company’s policies, to the best of my knowledge and belief.

SUPERVISOR NAME:
DATE:

SIGNATURE OF COMPANY
SUPERVISOR