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Education
MALAYSIA
REQUIREMEI\JTS FOR PHOTOGRAPHS
o in colour and identical, not black and white
= taken against a BLUE background
50 millimetres (mm) high x 35 mm wide
Education Malaysia Global Services
o be free from reflection or glare on spectacles, the frames of which must not cover the eyes
e free from shadows
o taken with the eyes open and clearly visible (with no sunglasses or tinted spectacles, and\no
hair across the eyes)- if possible, recommend photographs without spectacles to avoid the
risk of rejection because of glare or reflection
with the subject facing forward, looking straight at the camera
with a neutral expression with the mouth closed (no grinning, frowning or raised eyebrows)
of each person on their own (no objects such as dummies or toys, or other people visible)
taken with nothing covering the face
in sharp focus and clear
be free from "redeye"
o be taken of the full head, without any covering unless worn for religious or medical reasons
o be printed professionally or taken in a passport photo booth. Photos printed at home are
unlikely to be of an acceptable standard
have the person's full name on the back of each photograph. (if submitted manually)
Pagel Requirements-for-Photographsvl.2
HEALTH EXAMINATION GUIDELINES
FOR ENTRY INTO
MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS
1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM.
2. PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE.
3. PLEASE WRITE IN CAPITAL LETTERS.
4. THIS FORM HAS 4 SECTIONS ;
(a) SECTION 1 (PART A AND B) TO BE FILLED BY THE APPLICANT ; AND
( b ) SECTION 2, 3 AND 4 TO BE FILLED BY THE EXAMINING DOCTOR
5. PLEASE COMPLETE ALL THE TESTS REQUIRED IN THIS FORM.
6. THE UNIVERSITY I COLLEGE ONLY ACCEPTS MEDICAL EXAMINATION DONE WITHIN
60 DAYS BEFORE REGISTRATION OR WITHIN 30 DAYS AFTER REGISTRATION.
7. PLEASE ATTACH ALL THE ORIGINAL LABORATORY RESULTS.
8. PLEASE BRING ALONG CHEST X-RAY FILM AND REPORT FOR REGISTRATION.
9. PLEASE ENSURE THE X-RAY FILM IS LABELLED WITH YOUR NAME AND DATE TAKEN
(IN ENGLISH)
10. CHEST X-RAY DONE WITHIN 6 MONTHS PRIOR TO REGISTRATION CAN BE ACCEPTED.
Lampiran A
11. THE UNIVERSITY I COLLEGE RESERVES THE RIGHT TO REPEAT FULL MEDICAL CHECK-UP OR ANY
SPECIFIC LABORATORY TESTS SHOULD THERE BE ANY DOUBT IN THE MEDICAL REPORT
SUBMITTED ALL COSTS INVOLVED SHALL BE BORNE BY THE CANDIDATES.
12. THE UNIVERSITY I COLLEGE RESERVES THE RIGHT TO REJECT ANY APPLICATION :
(a) BASED ON THE RESULTS OF THE HEALTH EXAMINATION ; OR
(b) SHOULD THERE BE ANY EVIDENCE THAT THE APPLICANT HAS GIVEN FALSE INFORMATION
IN THE HEALTH EXAMINATION REPORT OR ANY SUPPORTING DOCUMENTS.
!
PLEASE USE CAPITAL LETTERS
HEALTH EXAMINATION REPORT
FOR INTERNATIONAL STUDENT
AND ACCOMPANYING PERSON
SECTION 1 (To be completed by candidate)
(PART A)
FULL NAME (AS IN PASSPORT)
Passport size
photo
I I I I I Fll---t--1 -1---{-1 1--t-1 t--1:----+--+1 l-r-1 +---+--1 1--+--+1 1-l--1 ---t--t-1 1--t-1 11--+-1 -t--1:- 1--+---il I
INTERNATIONAL PASSPORT NO.
I I I I I
NATIONALITY
I I I I I
DATE OF BIRTH AGE
I I I I I I I I I
D D M M Y Y
ACADEMIC YEAR
I I I I I I I I
PROGRAMME OF STUDY
SEX B
MALE
FEMALE
STUDENTID
I I I I I
IIIII Pr-11 ' 1111111111
NEXT OF KIN
I I I I I I I I I I I I
NEXT QF KIN'S ADDRESS
CONTACT NUMBER
I I I I I I I I I I I
MARITAL STATUS B
SINGLE
MARRIED
I I J
PROGRAMME CODE
I I I I I
B 1111111 F i l l ~ 1111111111111111
NEXT OF KIN'S CONTACT NUMBER
I I I I I I I I I I I
SECTION 1
(PART B)- Please tick (.,;) in the relevant box ~
Dedaration of self and family illness. Explain in full if you or your family has any of the following illnesses.
* Immediate family refers to father, mother, brothers I sisters
SELF IMMEDIATE
MEDICAL PROBLEMS FAMILY If "Yes" please state
YES NO YES NO
1. Congenital or inherited disorder
2. Allergy
3. Mental illness
4. Fits, stroke, other neurological disease
.
5. Diabetes Mellitus
6. Hypertension
7. Heart or vascular disease
8. Asthma
9. Thyroid disease
10. Kidney disease
11. Cancer
12. Tuberculosis
13. Drug addiction
14. AIDS, HIV
15. History of surgery
16. Other illnesses
Current medication (Long Term)
IMMUNIZATION HISTORY DATE IMMUNIZED
( where applicable )
1. Yellow Fever
2. BCG
3. Meningitis ( Quadrivalent )
4. Hepatitis 8 .
5. Others :
I hereby certify that the information given above is true. I understand that my applicati on will be rej ected if
there is any false information given.
Date Signature of candidate
2
SECTION 2 - PHYSICAL EXAMINATION
To be filled by examining doctor
1. BASIC MEASUREMENT
HEIGHT : m
WEIGHT : kg
VISION TEST : Unaided : (R) _ _ (L)
Aided : (R) (L)
2. GENERAL EXAMINATION
ITEM
I
YES
a. DEFORMITIES
b. PALLOR
c. CYANOSIS
d. JAUNDICE
e. OEDEMA
f. SKIN DISEASES
2. GENERAL EXAMINATION
ITEM
I NORMAL
a. EYES (including funduscopy)
b. EARS
c. NOSE
d. ORAL CAVITY /THROAT
e. NECK
f. HEART
g. LUNGS
h. ABDOMEN I HERNIA ORIFICES
i. NERVOUS SYSTEM
j . MENTAL CONDITION
k. MUSCULOSKELETAL SYSTEM
\
BLOOD PRESSURE : mmHg
PULSE RATE: /min
COLOUR VISION TEST :
NORMAL I ABNORMAL
NO
I
COMMENT
--
_.:::_
I
ABNORMAL COMMENT
3
SECTION 3 - INVESTIGATIONS
URINE TEST
ITEM DATE TAKEN COMMENT
a. ALBUMIN
b. SUGAR
c. MICROSCOPIC
I
d. MORPHINE
e. CANNABIS
f. AMPHETAMINES TYPE
STIMULANT
BLOODTEST
-
TrEM-----------r--DATE-TAKEN ____ r _________ COMMENT-
a. HEPATITIS Bs ANTIGEN
b. HEPATITIS C
c. HIV
d. VDRLITPHA
I
e. MALARIAL PARASITE
CHEST X- RAY INFORMATION
CHEST X- RAY NO.
DATE TAKEN
PLACE TAKEN
REPORT
/
4
SECTION 4- CERTIFICATION BY THE DOCTOR
Please tick (.../) in the appropriate box
I certify that I have on this date ________ examined
Mr I Ms Passport No. _____ _
and found him I her :-
D IN GOOD HEALTH
D HAVING THE FOLLOWING MEDICAL COMPLICATIONS (S) (Please State)
D UNDERGOING TREATMENT FOR: (Please State)
Date Signature of Doctor
Name of Doctor
Qualification
Hospital I Clinic
Registration Number
Official Stamp
Remarks By Universify I College Official :
5
"
Certified: Duplicates of original documents, certified as exact reproductions, usually by the officer responsible for issuing or keeping the
original, or by a solicitor, notary public, justice ofthe peace or any other person authorised to take a statutory declaration. A certified
copy should carry a certificate, stamp or seal, and the certifier's signature.
If you send us a document that is not in English or Bahasa Malaysia in support of your appl ication, this document must be accompanied by a
full translation into English that can be independently verified by EMGS.
The original translation must contain:
.
a) confirmation from the translator or translation company that it is an accurate translation ofthe original document;
b) the date ofthe translation;
c) the full name and signature ofthe t ranslator or of an authorised official of the translation compal'ly; and the translator or translation
company's contact det ai ls.
Student Pass Document (I HE) v1.6