BORANG KEBENARAN WAKIL AMBIL / PULANG JUBAH KONVOKESYEN BAGI

PIHAK GRADUAN
AUTHORISATION FORM FOR THE COLLECTION / RETURNING OF THE
CONVOCATION ROBE ON BEHALF OF THE GRADUATE
AMBIL JUBAH
COLLECTION OF THE ROBE

PULANG JUBAH
RETURNING OF THE ROBE

*CATATAN : Sila tandakan ( / ) Please tick ( / )

MAKLUMAT GRADUAN Graduates Particulars
Nama Graduan : ________________________________________________________________________________
Name of Graduand

No. Matrik : ______________________________________________________________________________________

Matric No.

Nombor Kad Pengenalan/No. Paspot : ___________________________________________________________

Identity Card/Passport Number

Nama Program : _________________________________________________________________________________

Programme Name

Saiz Jubah :
Robe Size

MAKLUMAT WAKIL Representatives Particulars

Dengan ini mewakilkan penama di bawah *mengambil/*memulangkan jubah konvokesyen bagi
pihak saya:I hereby authorise the person as below to *collect/*return my convocation robe on my behalf: Sila tandakan dibahagian * / Please tick

Nama Wakil : ___________________________________________________________________________________

Name of Representative

Nombor Kad Pengenalan/Paspot : _______________________________________________________________

Identity Card/Passport Number

No. Matrik : ______________________________________________________________________________________

Matric No.

Hubungan : _____________________________________________________________________________________
Relationship

PERAKUAN PENERIMA Consent of Receiver

_______________________
Tandatangan Penerima

Tarikh: _____________________

Signature of Receiver

Date

(Nama :____________________________________)
Name

MAKLUMAN Note:
Borang ini hendaklah dibawa oleh wakil bersama-sama dokumen berikut :
Please bring this form together with the following documents:

Surat Jemputan Invitation Letter

Yuran Konvokesyen Proof of Convocation Fee
Slip Kajian Pengesanan Graduan Tracer Study Slip
Borang Alumni UUM
Wakil hanya dibenarkan mengambil dua (2) set jubah konvokesyen sahaja.
A representative is allowed to collect only two (2) sets of the convocation robe.