REFERRAL CONFIRMATION FORM

Kindly ensure your have read the Referral Procedure before completing the form below.

Referral Confirmation Form

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Date and Time: *

STUDENT’S INFORMATION

Please fill in all of the required information.

Full Name *

Student ID *

Phone *

Email *

Program *

Kindly attach your referral memo received from Centre of Academic (CoA) *

Maximum upload size: 2.1MB

REFERRAL PAYMENT FEE

You are required to pay the referral fee according to the referral memo received in order for the Centre of Academic Department to process your request. (Beneficiary Name : University College of Aviation Malaysia; A/C Number : 26242900024428; Beneficiary Bank : RHB Bank)

Date of Payment *

Payment Referance Number *

Kindly upload your receipt of Payment *

Maximum upload size: 2.1MB

Declaration *

I hereby confirm that I have read, understood, and fully agree to all the terms and conditions outlined in the referral assessment memo. I acknowledge that failure to meet the stated deadline will result in an automatic failure of the module. I also understand that any false or incomplete information provided may lead to the rejection of my referral request by UniCAM.

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