KTJ Registration Form Section A : Student Particulars PHOTO
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.
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