For TPI Mentor’s Use Only

SCHOOL OF EDUCATION, HUMANITIES AND SOCIAL SCIENCES

Teaching Practice and Internship MENTOR Claim Form

Semester: January May September Year _________________

Name of Mentor
(Name as in Bank Account in block letters)
Pls make sure that the account is under
your name
Institution Affiliation

Mentor’s Country of Origin

and address (for non-Malaysian)
IC/Passport Number
Email Address:
Contact No:
Mode of Payment Banked into Account
Bank (Local)
Bank Account Number (Local)

Mentor Claim for TWO (2) lesson observations / assessment

Total* Checked by
Student Name Student ID
(RM) TPI Coordinator

Grand Total

*To be paid RM 300 for completing TWO (2) lesson observations / assessment.

Claimed by TPI Mentor: Signature: Date:

Checked by TPI Course Coordinator: Signature: Date:

Approved by Dean: Signature: Date:

Reminder/Information:
1. Use only the WOU’s official claim form & attach 2 sets of TPI Assessment Form, 2 sets of TPI Feedback Form and 1 set of TPI
Final Report per student. Also, attach a copy of your I.C. (for Malaysians) or passport – the page with your photo and
particulars (for non-Malaysians) and a copy of your bank statement (the page with your name and account number).
1. TPI Mentor Claim Form is to be submitted after students have completed the TPI.

For Administrative and Financial Use:

Date received from TPI Mentor: ..………….……….. (by Course Co-ordinator)

Revised: 17 January 2022

LETTER FOR GIRO TRANSFER FORM

Dear Professor / Dr / Sir / Madam,

To facilitate payment for your claim, please complete and provide the following:

FOR INDIVIDUAL

1) Completed Giro Fund Transfer Form

2) Photocopy of Identity Card (cross and write “for WOU only”)
3) Photocopy of Bank Statement (just the top portion showing your name, bank
account number and correspondence address.
Account number to be the same as stated in the Giro Fund Transfer Form)

FOR COMPANY

1) Completed Giro Fund Transfer Form

2) Photocopy of Form 9 / Registration of Business Certificate (Partnership / Sole
Proprietor)
3) Photocopy of Form 13 (if there is any change of company name)
4) Photocopy of Bank Statement (just the top portion showing the bank account’s
name, account number and correspondence address.
Account number to be the same as stated in the Giro Fund Transfer Form)

KINDLY SUBMIT THESE DOCUMENTS TOGETHER WITH YOUR CLAIM FORM.

Thank you.