Malaysian Student Application Form Chinese


No. 1 Persiaran Bukit Utama, 47800 Petaling Jaya,
Selangor Darul Ehsan, Malaysia.
Tel:+603-7735 2088 Hotline: +6016-301 8166, +6016-302 8166
1. The application form must be completed and signed by the applicant.
2. Certified true copy of relevant certificate(s) must be attached with the application:-
a) One copy of the SPM result or equivalent;
if applicant is waiting for his/ her results, please submit a copy of the school’s forecast result or trial examination results.
b)One copy of the STPM result or any Diploma / Certificate or equivalent (if applicable).
c)One copy of the School Leaving Certificate/ Testimonial.
3. One copy of I/C or passport and four passport size coloured photographs.
4. The application must be accompanied by a non-refundable application fees.
All payments by Cheque / Bank Draft / Money order must be made in favour of 'First City Corporation Sdn Bhd'.
For Office Use Only
Student No: Offer:*FullInitial : 
Course Code: *On ForecastDate : 
Intake: *ConditionalAgent Name: 
Personal Particulars
(as stated in your I/C)
Correspondence AddressMobile Phone House Phone
E-mail AddressRaceGender
ReligionMarital Status
Date of BirthI/C No

(12-digit numbers without "-")

Name of Parent / Guardian
Occupation of Parent / Guardian
Permanent Address(if different)Mobile Phone House Phone
E-mail Address of Parent / Guardian
Programme Particulars
Programme Applied for
Commencement Date
Foundation: Feb, June, Sept
Diploma: Jan, June, Oct
Degree: Feb, June, Sept
Academic Qualifications
Examination results of SPM / IGCSE / Senior Middle IIIYear Taken: 
Academic Qualifications
Examination results of STPM / GCE A-Levels / Year Taken: 
Name of School / College / University AttendedYear
Employment Particulars(if Applicable)
Employer:Tel No:
Position Held:From:To:
Health Declaration
Do you have any disability(ies) or long term medical condition?NoYes
If yes, please state the type of disability and attach all relevant document(s).
Payment and Fees Refund Policy
Fees may be paid by crossed cheque or online banking, made in favour of FIRST CITY CORPORATION SDN. BHD.
Fees may also be paid by credit card (payment made in campus).
Fees paid are not transferable.
The Application Fee is not refundable.
The Tuition Fee is not refundable except where appropriate written notice is received by the Registrar, as follows:
  1. If written notice is received no less than one month before commencement of the programme/semester/term: Full Tuition Fee paid less RM500 administrative charges and any costs incurred by the University College.
  2. If written notice is received less than one month before commencement of the programme/semester/term: 50% of the Tuition Fee paid less RM500 administrative charges and any costs incurred by the University College.
There will be no refund after the commencement of the programme/semester/term.
The University College will refund all fees paid in the event the programme the student applied for is not conducted.
In the event the University College withdraws an offer due to inaccurate and/or misleading information provided by the student, 10% of the total fees paid will be deducted as processing fee provided the student has not commenced his/her programme of study. In the event the student has commenced his/her programme of study, the quantum of refund shall depend on, the period the student has attended classes and laboratory/workshop sessions, and deduction made for administrative charges and any other costs incurred by the University College.
Refund of the Security Deposit**, without interest will be subject to the following:
  1. Submission of the duly completed Request for Refund Form within 6 months of leaving the University College, failing which the security deposit will be forfeited.
  2. The student leaves the University College in good standing.
  3. Deduction for loss or damage to library books, damage to the University College’s property and any other costs incurred by the University College caused by the student.
  4. In the event that the student fails to attend classes for two consecutive semesters without officially informing the Registrar in writing and obtaining his written consent, the Security Deposit will be forfeited.
Privacy Statement
Your personal information collected in this Application Form or otherwise provided in support of your application (“Personal Data”) is processed, retained and used by First City University College in accordance with the Malaysian Personal Data Protection Act 2010 (PDPA). Your Personal Data may be collected from or disclosed to relevant bodies including your parents/guardians/sponsors, government agencies, etc. for the verification of your grades, qualifications and/or experience, and/or as otherwise required of First City University College by applicable laws or relevant authorities. First City University College may also retain and continue to process your Personal Data after your completion of the programme enrolled for, or otherwise upon you ceasing to be a student of First City University College, for archiving purposes, First City University College’s alumni events and activities and/or to maintain record of your grades qualifications and/or experience as may be required by First City University College and/or meet requests by other institutions with whom you enroll for other programmes hereafter.
All documents that you provide to First City University College become the property of First City University College and will not be returned to you. You have the right to access or update your Personal Data, or make inquiries or submit any concerns thereto, by contacting the Registry Office at
I hereby declare that the information in this Application Form, or provided in support of my application, is correct and complete. I acknowledge that the provision of incorrect information or the withholding of relevant information relating to my application, including academic transcript(s), may invalidate my application, and that First City University College may withdraw an offer or cancel my acceptance of First City University College’s Offer in consequence thereof. Should First City University College determine that I have submitted a false document, I consent to First City University College disclosing this information to other relevant tertiary institutions/authorities without any liability whatsoever.

I further confirm and consent to the use by First City University College, without charge, my personal information including photographs, images or recordings of me in any publicity and/or promotional exercise of First City University College, including the publishing of examination results, the award of a prize or scholarship, and any achievement, academic or otherwise.

I understand that First City University College shall be deemed to have notified me in writing if any mail is posted to the most recent mailing address that I have provided in writing to the University College.

I also agree to abide by the policies, rules and regulations of the respective Faculties/Centres of First City University College at all times.

I have read and understood the Payment and Fee Refund Policy and the Privacy Statement and agree and accept them fully.

Declaration by Parent/Guardian (if applicant is below 18 years)
I hereby agree to promptly pay all fees, charges and security deposits due as stipulated by First City University College. I also understand and agree that if I default in paying any of these, First City University College has the right to bar my child/ ward from attending classes, and impose penalties up to and including deregistration. I have also read and understood the Payment and Fees Refund Policy and agree to the terms as stated. I hereby apply for admission of my child/ward to First City University College as a student and I undertake to pay all tuition fees and charges until completion of the programme of study applied for.

Name of Parent/Guardian:
MyKad Number:
Documentations upload required:
1. Academic Transcripts & Certificates:* (Multiple files is allowed)
2. Copy of NRIC:*
(Front side copy of NRIC)
(Back side copy of NRIC)
3.Portfolio (Artwork) / Bank-in Slip (Optional) :