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Unisel/InTra/08/05

INDUSTRIAL TRAINING PROGRAMME


REPORT DUTY FORM
TO BE FILLED BY STUDENT
Faculty

_____________________________________________

Programme

_____________________________________________

Student Name

_____________________________________________

Matric Number

_____________________________________________

Date

_____________________________________________

Organization Name

_____________________________________________

Organization Address

_____________________________________________
_____________________________________________

Duration

___________________

Until ___________________

TO BE FILLED BY COMPANY SUPERVISOR


Supervisors Name

_____________________________________________

Designation

_____________________________________________

Department

_____________________________________________

E-mail Address

_____________________________________________

Phone Number

_____________________________________________

Companys Name

_____________________________________________

Trainees Allowance (if any)

RM__________________________________________

__________________________
(Signature Company Supervisor)
Date : ____________________

Company Rubber Stamp

Note : Company Supervisor please fax or post this form directly to the following address on or before end of first
week of reporting duty by the student.
_________________________________________________________________________________________________
Center for Business, Consultancy & Industrial Linkages (BCI), Universiti Industri Selangor
Jalan Zirkon A 7/A, Seksyen 7, 40000 Shah Alam, Selangor Darul Ehsan
Tel : 03-5522 3511/5522 3400 faks : 03-5522 3441
http://www.bci.unisel.edu.my

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