Thursday : 18th September 2014
 

 

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Cosmopoint College of Technology - CICT
     
 
  Online Registration Form      
 
     
 

 

 
PERSONAL DETAILS
Fields marked with * are mandatory.
Mr
Mrs
Miss
Name*
Email*
IC/Passport*
Sex
Male
Female
Date of Birth
Nationality
Contact Address*
City
 
Postcode
State
 
Tel No*
eg:037894563
Mobile
eg:0137894563
Fax
eg:037894563
 
 
 
Highest Academic Qualification
Phd
MSc
Degree
Diploma/Advance
STPM / O Level
SPM / A Level
Others
 
PARENT / GUARDIAN DETAILS
Name of Father/Guardian
Relationship
Address
City
State
Postcode
Tel No
H/P No
Fax No
 
Education Advisor Name / ID (Optional) : 
 
 
Signature*
(Please insert your name)
Date
Note : Please only check appropriate and applicable boxes
 
 
     

Cosmopoint International College Of Technology
 
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