APPLICATION FOR ADMISSION

Reference Number : A-052014-00519 A. PERSONAL INFO

FULL NAME DATE OF BIRTH PLACE OF BIRTH GENDER MARITAL STATUS ETHNICITY RELIGION PASSPORT / IC NO NATIONALITY CONTACT HOME PHONE DAYTIME PHONE (IF DIFFERENT) EMAIL HOME ADDRESS : 0380520667 : 0132853376 : theesigan2009@hotmail.com : NO1, 5/20 JLN PP, TAMAN PUTRA PRIMA : MR THEESIGAN : 08/07/1996 : TANJONG KARANG : Male : SINGLE : INDIA : HINDU : 960708105181 : MALAYSIA Application Type : Foundation Local

CITY STATE POSTAL CODE COUNTRY

: PUCHONG : SELANGOR : 47100 : MALAYSIA

B. FAMILY INFO
GUARDIAN FULL NAME PASSPORT / IC NO. NATIONALITY GENDER MARITAL STATUS : ATHIAPPAN : 700816085375 : MALAYSIA : Male : MARRIED

APPLICATION FOR ADMISSION

Reference Number : A-052014-00519
RELATIONSHIP WITH GUARDIAN NO OF DEPENDENTS CONTACTS HOME PHONE HANDPHONE EMAIL ADDRESS OCCUPATION EMPLOYER POSITION MONTHLY GROSS INCOME GUARDIAN WORK FOR PETRONAS OR A SUBSIDIARY OF PETRONAS EMPLOYER (PETRONAS) EMPLOYEE'S NUMBER PETRONAS SPONSORED SIBLINGS : 0380520667 : 0122007804 : task9181@gmail.com : ELECTRICITY/GAS & WATER SUPPLY : KEJURUTERAAN LETRIK TASK : LABOUR : RM 1001 - RM 2000 : No : : : FATHER : 4

There is no PETRONAS sponsored siblings

FATHER'S FULL NAME PASSPORT / IC NO. OLD IC NO., POLICE, MILITARY NATIONALITY FATHER'S MARITAL STATUS FATHER'S STILL ALIVE HOME PHONE HOME ADDRESS

: ATHIAPPAN A/L MARAPPEN : 700816085375 : : MALAYSIA : MARRIED : Yes : 0380520667 : NO1, 5/20 JLN PP, TAMAN PUTRA PRIMA

CITY POSTCODE

: PUCHONG : 47100

APPLICATION FOR ADMISSION

Reference Number : A-052014-00519
STATE COUNTRY OCCUPATION EMPLOYER POSITION MONTHLY GROSS INCOME FATHER WORK FOR PETRONAS OR A SUBSIDIARY OF PETRONAS EMPLOYER (PETRONAS) EMPLOYEE'S NUMBER MOTHER'S FULL NAME PASSPORT / IC NO. OLD IC NO., POLICE, MILITARY NATIONALITY MOTHER'S MARITAL STATUS MOTHER STILL ALIVE HOME PHONE HOME ADDRESS : SELANGOR : MALAYSIA : ELECTRICITY/GAS & WATER SUPPLY : KEJURUTERAAN LETRIK TASK : LABOUR : RM 1001 - RM 2000 : No : : : NERMALA A/P PALDRAMAN : 700327105960 : : MALAYSIA : MARRIED : Yes : 0380520667 : NO1, 5/20 JLN PP, TAMAN PUTRA PRIMA

CITY POSTCODE STATE COUNTRY OCCUPATION EMPLOYER POSITION MONTHLY GROSS INCOME MOTHER WORK FOR PETRONAS OR A SUBSIDIARY OF PETRONAS

: PUCHONG : 47100 : SELANGOR : MALAYSIA : UNEMPLOYED : : : RM 0 : No

APPLICATION FOR ADMISSION

Reference Number : A-052014-00519
EMPLOYER (PETRONAS) EMPLOYEE'S NUMBER : :

C. PROGRAMME CHOICE
FIRST CHOICE SECOND CHOICE THIRD CHOICE : PETROLEUM ENGINEERING FOUNDATION : PETROLEUM GEOSCIENCE FOUNDATION : CHEMICAL ENGINEERING FOUNDATION

D. ACADEMIC QUALIFICATION INFORMATION

MUET NO : NO RESULT : NA QUALIFICATION CATEGORY OF FIELD OF STUDY FINAL STUDY (FOR (FOR DIPLOMA, CGPA/OVERALL DIPLOMA, MATRICULATION MARKS/%/GRADE MATRICULATION & FOUNDATION) /BAND & FOUNDATION) NA

NAME OF SCHOOL / DATE OF COLLEGE / UNIVERSITY COMPLETION (mm/yyyy)

MRSM KUALA KUBU BHARU

11/2013

SIJIL PELAJARAN MALAYSIA (SPM)

E. QUALIFICATION DETAILS
NO 1 2 3 4 5 6 7 8 9 QUALIFICATION SIJIL PELAJARAN MALAYSIA (SPM) SIJIL PELAJARAN MALAYSIA (SPM) SIJIL PELAJARAN MALAYSIA (SPM) SIJIL PELAJARAN MALAYSIA (SPM) SIJIL PELAJARAN MALAYSIA (SPM) SIJIL PELAJARAN MALAYSIA (SPM) SIJIL PELAJARAN MALAYSIA (SPM) SIJIL PELAJARAN MALAYSIA (SPM) SIJIL PELAJARAN MALAYSIA (SPM) SUBJECT OR SEMESTER BAHASA MELAYU (BM) BAHASA INGGERIS (BI) MATEMATIK MATEMATIK TAMBAHAN FIZIK KIMIA PENDIDIKAN MORAL SEJARAH BIOLOGI CGPA / GRADE AA A+ A+ AB+ A+ A A-

F. EXTRACURRICULAR INFORMATION

APPLICATION FOR ADMISSION

Reference Number : A-052014-00519
NO 1 2 3 SPORTS / CLUB / SOCIETY / UNIFORM BODY / AWARD VOLLEYBALL INTER MRSM VOLLEYBALL MSSD FAMILY HARMONY CLUB BEGIN (mm/yyyy) 04/2013 03/2013 03/2012 END (mm/yyyy) 05/2013 04/2013 06/2013 LEVEL OF INVOLVEMENT Kebangsaan / National Daerah / District MRSM / SBP / School Category POSITION Pemain / Player Pemain / Player Naib Pengerusi / Vice Chairman

G. EMPLOYMENT HISTORY
There is no employment history

SUPPLEMENTARY DOCUMENTS
There is no supplementary documents