KTJ
P R I M A R Y
PHOTO
SECONDARY
OF
Kolej TuanKu ja'afar
APPLICANT
Registration Form
Section A : Student Particulars
Full name (as per passport) : ___________________________________________________________________________________
First name : _________________________________________________________________________________________________
NRIC : ____________________________
D D / M M / Y Y Y Y
D.O.B : _______________________
Passport number : ____________________________
Religion : _______________________
Country of birth : ____________________
Gender :
Male
Female
Nationality : ______________________________
Ethnicity (MOE requirement) : ______________________________________________
Proposed date of entry : _______________________
Starting Form / Year : __________________________________________
Home address : ______________________________________________________________________________________________
_________________________________________________________________________________________________
Students email : __________________________________________
How many siblings do you have :
Home number : ____________________________________
Ages : ________________________________________________________
Languages spoken at home : ____________________________________________________________________________________
Day student
Boarding student
How did you find out about the KTJ ?
Friends
KTJ student / family
Press
Seminar / Exhibition
Agent ________________________________
Section B : Present School Details
Name of School : __________________________________________________
Date started : ________________________
Address : ___________________________________________________________________________________________________
Contact person : _____________________________________
Contact number : ____________________________________
Language of instruction : _______________________________________________________________________________________
Section C : Parent & Guardian Particulars
Send invoices to
Father
Mother
Fees are paid by
Parent
Grandparent
Guardian
Send to
Parent’s employer
Home address
Guardian
Agent
Office address
Other
Father : _____________________________________________________________________________________________________
NRIC / Passport number : ___________________________________
Profession : ____________________________________
Company name : _____________________________________________________________________________________________
Office address : ______________________________________________________________________________________________
Personal email : ________________________________________
Mobile number : __________________________
Work email : _________________________________________
Work number : __________________________________________________
Mother : ____________________________________________________________________________________________________
NRIC / Passport number : ___________________________________
Profession : _____________________________________
Company name : _____________________________________________________________________________________________
Office address : ______________________________________________________________________________________________
Personal email : ________________________________________
Mobile number : __________________________
Work email : _________________________________________
Work number : __________________________________________________
KTJ
P R I M A R Y
SECONDARY
Kolej TuanKu ja'afar
Guardian name : __________________________________________________
NRIC / Passport number : ___________________________________
Relationship : ___________________________
Profession : ____________________________________
Company name : _____________________________________________________________________________________________
Office address : ______________________________________________________________________________________________
Personal email : ________________________________________
Mobile number : __________________________
Work email : _________________________________________
Work number : __________________________________________________
Section D : Additional Information
Learning Support
The following information will not adversely affect the application, so please provide full and honest responses.
Please identify any learning difficulties that your child has or has had and outline any special learning support they have received.
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Please provide details of any medication that your child is currently taking or has previously taken.
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Please advise if your child has had an educational assessment.
YES
NO
Hobbies & Interests
Please outline any hobbies or interest that your child enjoys. This can include the arts, music, sports or any other activities that your child
is involved in. For example, please identify any teams that your child has played for or their level of proficiency playing a musical
instrument.
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Section E : Signatures
Kolej Tuanku Ja’afar reserves the right to use your child’s image in all marketing and advertising material, including but not limited to
print ads and video. If you do not want to allow the use of your child’s image in our advertising, please tick this box.
The Parent shall give to the School written or email notice of their intention to withdraw the Student from the School, with at least 1 clear
term prior to the date on which the Student is actually withdrawn. In default of such notice, the deposit shall be forfeited. The deposit
may not be used to offset fees in a Student's final term. Please sign to confirm acceptance.
Signature : ________________________
NOTE
- Documents to be submitted together with this Application are listed under Entrance Documentations Required
DECLARATION
I/We agree to be bound by the conditions of entry which I/we acknowledge to have been read by me/us and which shall form part of my/our agreement with the Kolej with respect to the Pupil. I/We also
agree to be bound by the resolutions and regulations made by the Board of Trustees from time to time with regard to the conduct of the Kolej. I/We accept responsibility for the Pupil’s compliance where
applicable.
DATE :
SIGNATURE OF FATHER
SIGNATURE OF MOTHER
D D / M M
/
Y
Y Y Y
KTJ
P R I M A R Y
SECONDARY
Kolej TuanKu ja'afar
Emergency Contact Form
In the case of an emergency, who should we contact first?
Mother
Father
Guardian
We will use the contact details provided on the Registration Form, unless otherwise specified here:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Please provide the details for three additional people who we can call in the event that we cannot contact the people already
listed above.
(1)
Name: __________________________________________________________________________________________________
Relationship to student :____________________________________________________________________________________
Address :
______________________________________________________________________________________________
_______________________________________________________________________________________________________
Mobile number : __________________________________________________________________________________________
Home number : __________________________________________________________________________________________
Work number:____________________________________________________________________________________________
(2)
Name : ________________________________________________________________________________________________
Relationship to student :____________________________________________________________________________________
Address :
______________________________________________________________________________________________
_______________________________________________________________________________________________________
Mobile number : __________________________________________________________________________________________
Home number : __________________________________________________________________________________________
Work number : __________________________________________________________________________________________
(3)
Name : ________________________________________________________________________________________________
Relationship to student :____________________________________________________________________________________
Address: ________________________________________________________________________________________________
_______________________________________________________________________________________________________
Mobile number : __________________________________________________________________________________________
Home number : __________________________________________________________________________________________
Work number : __________________________________________________________________________________________
KTJ
P R I M A R Y
SECONDARY
Kolej TuanKu ja'afar
Checklist – Items to return to KTJ
All Applicants
Registration Form
RM350 registration fee
NRIC of student and parents / passport photocopies if non-Malaysian
Most recent school report
Testimonial from current school
1 passport sized photograph
Medical Insurance - Private or AXA Smart Cover
International Students
Both parents' passport photocopies
Parents' marriage certificate
Student's birth certificate
IGCSE Applicants (in addition to the above for ‘All Applicants’)
IGCSE subject choices form
A Level Applicants (in addition to the above for ‘All Applicants’)
IGCSE or SPM forecast results
A Levels subject choices form
Office Use Only:
Engage entry complete
Proforma Invoice issued
Offer letter sent
Offer accepted
Methods of Payment:
Cheque (in RM)
Banker's Cheque /
Banker’s Draft
Payment via TT
Payable to Syarikat Pendidikan Staffield Berhad. Outstation cheques may incur additional
bank charges. Please note that the School will not bear any outstation cheque charges outside
of Negeri Sembilan, Kuala Lumpur, Selangor or Pahang in Malaysia.
Bank: Malayan Banking Berhad, Mantin Branch.
Account No: 005082103314
SWIFT Code: MBBEMYKL
Credit Card
Interest free for payments made on or before the start of term.
An interest of 2% is chargeable for payments made after the starting term.