FACULTY MANUFACTURING ENGINEERING
Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya, 76100 Durian Tunggal, Melaka, Malaysia www.utem.edu.my/fkp
Tel: +606 331 6019 I Fax: +606 331 6411 MOBILITY PROGRAM REGISTRATION FORM A : Personel Particulars
Name : ...
Passport No : ...
Gender : Male Female
Nationality : ...
Course : ...
Faculty : ...
University : . ...
Mailing Address: ...
...
City : ...
Mobile No. : ...
Email Address : ...
B : Registration Fee
Registration Fee : USD1000
Mode of payment : Bank Draf
Banker’s Cheque Electronic Fund Transfer Telegraphic Transfer
Details of account:
Bank draft/cheque made payable to BENDAHARI UNIVERSITI TEKNIKAL MALAYSIA MELAKA For Electronic Fund Transfer (EFT)
Beneficiary Name : Bank Islam Malaysia Berhad
Account No : 04-042-01-000083-3
Swift Code : BIMBMYKL
