APPLICATION FORM FOR ADMISSION

Method of Enquiry Walk-In SGS Referred by / Agent: _____________ Others____________

The following documents and Application Fee must be submitted with your application form for admission.
[ATTACH
Local Applicant (Checklist) RECENT
PHOTO]
 Two (2) Passport-Sized Photographs Size: 3.5cm x
 Original copy of Eligibility Letter 5.0cm
 Original copy of Offer Letter
 Signed Candidate’s Declaration (Appendix B)
 Certified True Copy of the following documents:
1. National Registration Identity Card (NRIC)
2. parent/guardian NRIC
3. Academic Qualification certificates e.g. SPM / O Level / STPM
4. MARDEP Medical health Screening Report
5. School Leaving Certificate
6. Birth Certificate
7. Candidate’s CIMB Bank account statement

PROGRAMME APPLIED FOR (please tick)

Diploma in Nautical Studies JPT/BPP(K)(R/840/4/0020) (MQA/A11142) 12/24

Diploma in Marine Engineering JPT/BPP(K)(R2/525/4/0063) (MQA/A11143) 12/24
Diploma in Maritime Management JPT/BPP(K) (N/0414/4/0009) (MQA/PA15560) 05/27
Diploma in Maritime Services JPT/BPP(K) (KPT:N/0414/4/0013) (MQA/PA15561) 05/27
Diploma in Maritime Transportation and Logistics/BPP(K) (KPT:N/0414/4/0010) (MQA/PA 15562) 05/27
Diploma in Maritime Business Administration JPT/BPP(K) (N/0414/4/0012) (MQA/PA15563) 05/27
DECK Rating (STCW)
ENGINE Rating (STCW)
Advance Diploma in Marine Engineering (ADME)
Advance Diploma in Nautical Studies (ADNS)

PERSONAL PARTICULARS

Name as stated in the Passport (in capital letters): Gender:

Male
Female
Nationality: Date of Birth: Age: Marital Status:

Single
Passport No: Race: Religion: Married
Others
Height: Weight: BMI: Colour Blind: Yes or No

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CONTACT DETAILS

Postal Address:

Post / Zip Code: City / State: Country:

Home Tel No: Mobile Phone No: Email Address (compulsory):

PARENT’S / GUARDIAN’S PARTICULARS

Parent / Guardian

Name: (as in NRIC) NRIC / Passport No:

Correspondence Address: Home Tel No:

Office Tel No:

Mobile Phone No:

Postcode: Email Address:

Employer: Monthly Income (Salary Range):

B40
M40
T20

Occupation: Relationship (if guardian):

Emergency Contact (other than parents)

Name: (as in Passport) Relationship:

Correspondence Address: Home Tel No:

Office Tel No:

Mobile Phone No:

Email Address:

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ACADEMIC QUALIFICATIONS (Please attach supporting documents)

Institution Qualification Year

Please provide details of the subjects taken and grades obtained:

Qualification: Qualification:
Subject Grade Subject Grade

English Language Proficiency

Examination Grade Year

MUET

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TERMS & CONDITIONS (REFUND POLICY)

1. A student is considered registered upon enrolment.

2. Fees payables are indicated in the programme fee structure. Please note that ALAM reserves the right to annually
review and revise the fees.
3. Fees due for the semester must be paid within two (2) weeks of the class start date. Failure to pay the fees on time
may result in the student being barred from classes, examinations, and access to campus facilities.
4. Application and Registration fees are Non-refundable.
5. Fees paid are generally non-refundable, except under the circumstances outlined below, and provided that a written
request (accompanied by official supporting documents) for fee transfer has been submitted.
a. Transfer due to National Service call-up (if any).
b. Transfer due to medical reasons.
6. The refundable/transferrable amount of fees or deposits will be determined after deductions are made against any
outstanding fees or payments owed to ALAM.
7. In the event of a student’s expulsion /suspension or discontinuation of the programme due to misconduct, all fees
paid are non-refundable.
8. A student on conditional offers whose actual results do not meet the entry requirements of the programme, is
eligible for a prorated refund of the paid tuition fees.

*ALAM reserves the right to review and amend the rules and regulations (including policies) at any time.

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DECLARATION

Applicant

I have read and fully understand all the terms and conditions governing admission before submitting this
application. I hereby declare that all information provided by me in this form, as well as any information
given in all other documents submitted with this form, is complete and accurate.

I also acknowledge that ALAM reserves the right to modify or revoke any decision regarding admission
and enrolment if minimum entry requirements are not met or if incomplete or inaccurate information is
provided.

I understand that ALAM has the right to use and store my personal information for ALAM’s purposes,
whether for commercial or non-commercial purposes. Additionally, I confirm that I have obtained all
necessary consent from third parties where I have provided their personal data as part of my application
(such as information relating to my parents) and I have extended a copy of this Application Form to the
third parties.

I consent to educational institution where I have previously been enrolled and/or my current or former
employers providing ALAM with information they hold about me for the purpose of verifying my grades,
qualifications and/or experience.

In the event that tuition fees are paid by an organisation (“Sponsor”), I authorise ALAM to disclose fee
and academic progress information to my Sponsor. Furthermore, I consent to ALAM releasing fee and
academic progress information to my parent or guardian.

Signature of Applicant Date:

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Parent / Guardian (if Applicant is below 18 years old)

I hereby agree to ensure timely payment of all fees as stipulated by ALAM. I understand and acknowledge
that ALAM reserves the right to take action, including deregistration, against my child/ward in the event
of default in payment of fee payment.

I confirm that I have read and fully understand all the terms and conditions governing admission for this
application. I hereby apply for my child/ward’s placement at ALAM.

I also acknowledge that ALAM has the authority to utilize and retain my personal information for ALAM’s
purposes, whether commercial or non-commercial. Additionally, I confirm that I have obtained all
necessary consent from the third parties, such as emergency contacts, where I have provided their personal
data as part of this application, and I have provided a copy of this Application Form to the them.

I consent to any educational institution where the Applicant has previously been enrolled and/or the
Applicant’s current or former employer, providing ALAM with information they hold about the Applicant
for the purpose of verifying the Applicant’s grades, qualifications and/or experience.

In the event that tuition fees are paid by an organisation (“Sponsor”), I authorize ALAM to release the
Applicant’s fee and academic progress information to the Sponsor.

Signature of Date:
Parent/Guardian

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PDPA Consent Clause

By submitting this Application Form for Admission, you hereby consent to the collection, processing,
and use of your Personal Data by ALAM for the purpose of processing your application and for
related administrative and academic purposes.

Your Personal Data will be handled in accordance with the provisions of the Personal Data Protection Act
(PDPA) 2010, and ALAM's Privacy Policy. ALAM is committed to protecting your privacy and ensuring the
security of your Personal Data.

Please scan the QR Code attached for more information on how we handle your Personal Data.

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FOR OFFICE USE ONLY

Sales and Marketing Department

Counselled by,

Documents Complete

Documents Incomplete _________________________________

Signature
Specify: Name:

Date:

Student Admissions & Records Division / Registry (REG)

Counselled by,
Documents Complete

Documents Incomplete
_________________________________
Specify: Signature

Name:
Checked by: Re-checked by:
Date:

Date: Date/Time :

Selection/ Interview Committee / Dean / Head

Firm Offer KIV

Rejected
_________________________________
Signature
Feedback to Applicant:
Name:

Date:
NOTE - Student Admissions and Records / Registry (REG) reserves the right to reject any application with incomplete documents / information.

Please return this form to:

REGISTRY
AKADEMI LAUT MALAYSIA (ALAM)
Batu 30, Kampung Tanjung Dahan,
78200 Kuala Sungai Baru, Melaka
Tel: +60 6388 2200
Tel: +60 6388 2200| Fax: +60 6388 2200| Email: alamintake@alam.edu.my | Website: http://www.alam.edu.my

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