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CHECKLIST
FOR UNDERGRADUATE APPLICATION FORM

Please submit all the following items along with the Undergraduate Application Form or Online Application
Form to ensure that your application is COMPLETE and can be processed for admission. Please tick (/) in the
appropriate boxes to indicate items that have been attached.

i. Non-refundable application processing fee of US$ 25.00 in the form of bank draft payable
to Finance
Director, International Islamic University Malaysia (applicable to international applicants
residing outside Malaysia) or RM 75.00 in the form of either Malaysian money order or postal
order payable to the Finance Director, International Islamic University Malaysia (applicable
to applicants who submit application forms in Malaysia);

ii. Certified copies (certification should be certified by authorized officer at the Ministry of
Education OR authorized law practitioner) of Higher School Certificate (HSC) / GCE ‘A’
Level or any other equivalent certificates;

iii. 3 copies of international passport book with at least 2 years validity (For International
Applicants only);

iv. 4 recent passport-sized, colored photographs;

v. Financial Statement and/or Undertaking letter from self/parent/guardian/sponsor;

vi. University Entrance Exam (only compulsory for countries which require to pass the Entrance
Exam for entry into the University in their respective countries);

vii. SAT 1 result (only compulsory for International schools which follows the American
education system)

Upon completion, this form should be returned to (post/email/by hand):

Admissions and Records Division (A & R)


International Islamic University Malaysia, Jalan Gombak,
P.O Box 10
50728 Kuala Lumpur, MALAYSIA
Fax: 603-6196 4724 Email: admissions@iiu.edu.my
URL: http://www.iiu.edu.my/anr
Any enquiry, contact: 603-6196 4000 (ext: 3024/3022)
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UG PHOTO
(4 copies – one
of them to be
pasted here)
UNDERGRADUATE APPLICATION FORM
CHOICE OF PROGRAMME OF STUDY
st
1 Choice:* 2nd Choice:*

PERSONAL DETAILS
Name as stated in the I/C / Passport (in capital letters):* Gender:
Male

Name to appear in the Student Card: (Maximum 9 characters) Female


Citizenship:* Date of Birth:* Age: Marital Status:
Single Married Others: __________
Identity Card/ Date of Expiry: Date & Place of Issue: Country/State of Origin:
International Passport No.:*

Country of Residence: Religion:* Denomination/Madzhab:* Ethnic Origin (Malaysian only):

Postal Address:*
Street:

Post / Zip Code:


City/
Country:
State:
Telephone No.:* Fax. No.: E-mail Address:*

Permanent Address (If different from the above):


Street:

Post / Zip Code:


City/
Country:
State:
Telephone No.: Fax. No.:

A. FAMILY DETAILS
Name of Father/Guardian:* Identity Card/Passport No.: Citizenship:*

Occupation:* Monthly Income:* No. of Dependants: Telephone No.:


(USD or RM) Fax. No.:
E-mail Address:
Address:

For Office Use Only: Reference No: Processing Fee


Date Received: Admission Qualification: Date of Verification:

Country Code:
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ADDITIONAL INFORMATION
i. Have you ever studied in any institution of higher learning?
Yes (If Yes, please fill in this Section) No

ii. Name and Address of the institution(s):

iii. Reasons for leaving:

Study/Course completed Dismissed Withdrew Others

If Others, please state:

B. DECLARATION
I hereby attest that I have personally filled in this Application Form and the information contained herein is complete and
accurate to the best of my knowledge. I understand that withholding or giving false information will make me ineligible for
admission and future enrollment. I further understand that I may be required to appear for an interview or to undergo such
test as requested by the University Board of Admission as a condition for admission to the programme of study for which I
have applied.

Applicant’s Signature:* Date:

* Required. Failure to fill in this column may result in your application being rejected.

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International Applicant's Financial Certification
(Required for Student Visa)

Instruction: You are required to complete this form and submit it together with your application for admission. Your application
package will not be processed without this financial statement.

Applicant's Name: ______________________________________ Ref. No (if any): ______________

In the name of Allah, I solemnly declare that:

I am able to pay the tuition fee in full and all other payments as required by IIUM throughout my studies. I am
also able to finance the living expenses of myself and my family (if any and if they are permitted by Malaysian
Immigration to accompany me).

I attached herewith undertaking letter and income tax statement/salary slip/bank statement of
myself/my parent/guardian.

Applicant's signature: _______________________ Date: ______________________

If you are sponsored, please have your sponsor fill out and sign the following:

Name of Organization/Institution/Sponsor: ___________________________________________________


Address: ______________________________________________________________________________
______________________________________________________________________________

Phone: ______________________________ Fax: ___________________________


Contact Person Name: ____________________________ Position: _______________________________

Relationship of sponsor to applicant: ________________________________________ ________________

“I hereby agree to sponsor the student for the length of his/her Undergraduate program at
International Islamic University Malaysia (IIUM).

Signature: _______________________ Date: _____________________


(Original signature required. Fax/scan copies are not accepted)