MALAYSIAN INSTITUTE OF

AVIATION TECHNOLOGY
DCAM Part 66 Module Examination Application Form
APPLICANT DETAILS
Name:
NRIC/Passport No: Contact No:
Candidate UniKL-MIAT Student (in-study) UniKL-MIAT Alumni
Category: UniKL-MIAT EASA External Candidate
E-Mail:
Program: ________________________________________________________________________
Category Applied ________ Tick box if first time sitting for the applied module examination.
Date of previous module exam sitting if this is not the first sitting

EXAMINATION MODULES
Note: Students are only allowed to apply for one (1) module at any one (1) time.
Consolidation class date confirm
Modules Mark where (if first exam sitting)
Examination date confirm
applicable (For UniKL MIAT use only)
(For UniKL MIAT use only)
Module 1
Module 2
Module 3
Module 4
Module 5
Module 6
Module 7
Module 8
Module 9
Module 10
Module 11A
Module 11B
Module 12
Module 13
Module 14
Module 15
Module 16
Module 17
I wish to apply for the examination module as indicated and confirm that the information contained in this form is
correct at the time of application. Copies of SPM and related examination result slip are attached. I also confirm that
on the date of this application, Im not being barred from taking module examination.

Signature: _______________________________ Date: _________________________

For UniKL MIAT use only

Exam Fee Received RM Receipt Number
Consolidation Class Fee
RM Receipt Number
Received (if applicable)
Signature Date