SEGi University & Colleges

Admission 2018

APPLICATION NO. :
SEGIKD/DENTISTRY/2018/0016

Applied Branch : Foundation in Science

Basic Info
Full Name NOOR LIYANA BINTI MOHAMMAD ZAMRI
Nationality MALAYSIA
Email LIYANALNN@GMAIL.COM
Mobile 0134180973

Personal Details
Name NOOR LIYANA BINTI MOHAMMAD ZAMRI
Gender FEMALE
Date Of Birth 24-10-2000
Race MALAY
Religion MUSLIM
Nationality MALAYSIA
Ic No 001024020298

Education Details
Name Of School/institution MAKTAB RENDAH SAINS MARA BALIK PULAU
Year Obtained 2017
Sejarah B+
Mathematics A
Bahasa Melayu A-

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Parents/Guardian Details
Father/guardian Name MOHAMMAD ZAMRI BIN YAHYA
Mobile 0195128591
House No. NO,38
Street KAMPUNG BUKIT PALONG,MUKIM BONGOR
Country MALAYSIA
State KEDAH
City BALING
Postcode 09100

DECLARATIONS:

1. I have read and understood the stated terms & conditions, complete requirements of the course and
eligibility criteria as indicated in the prospectus as well as on the website.
2. I hereby confirm that the information furnished by me here above is true to the best of my knowledge.
3. I undertake to comply with all the rules and regulations of the array as prescribed from time to time by the
college. Also, I accept that the university is free to initiate any appropriate disciplinary action against me if I
violate any of the stated rules and regulations at any point of time.

NOTE:

1.Please keep a copy of the filled in application for future reference.

2.Application number must be quoted in all future correspondence.