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Surau Al-Hikmah, Jalan SS 18/4, 47500 Subang Jaya, Selangor Darul Ehsan

MMaaddrraassaahh AAll--HHiikkmmaahh

No. Pendaftaran JAIS: SPS/PRP/08/7(SEM)-303

Tel: 03- 5636 1095 019- 281 6307

APPLICATION FORM

APPLICANT DETAILS

Name : ____________________________________________________

Passport/I.C. No. : ____________________________________________________

Date of birth : ____________________________________________________

Father’s name : ____________________________________________________

Mother’s name : ____________________________________________________

Contact person & no: ____________________________________________________

Postal address : ____________________________________________________ ____________________________________________________

EDUCATIONAL RECORD School attended (or furthest secular education) ________________________________

Level achieved _______________________________________ in the year _________

Madrasah attended (or furthest Islamic education) ______________________________

Level achieved _______________________________________ in the year _________

HEALTH Does the applicant suffer from any illness that would affect his studies or his stay at the institute? If yes, specify.

________________________________________________________________________

________________________________________________________________________

A guardian is person responsible for the student for the period of time outside madrasah. A guardian of a female student should be a muhrim.

Guardian’s name : __________________________ Relationship: _______________

Guardian’s contact : ____________________________________________________

Registration Fee Registration fee is RM400. The payment is made on the acceptance of student to study in the madrasah. The place of study shall not be reserved for student who has yet to pay this fee.

Annual Fee The annual fee is RM4800. Payment can be staggered into monthly payments. Payments shall be acknowledged in periodical statements. The final settlement shall be not later than October.

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Fees Card All students shall be issued a FEES Card. In each occasion, please make sure that the recipient of the fees is a member of the staff and signs the card to acknowledge the respective payment. All payments should be made to:

Name : MAH SJ Resources Bank : Bank Muamalat SS15/5A Subang Jaya No. : 1206-0002579-71-4 ACCEPTANCE

1. Submission of this form shall be considered as a formal application to study in the institution.

2. The decision of acceptance shall be made after a muzakarah session between the parents/guardians and mudir. The prospective student may be present.

3. The madrasah shall inform the applicant the status of the application as soon as possible, inshaAllah.

4. Application shall not be processed if the agreement below has not been signed. Kindly read carefully and sign only if you have agreed on all the terms mentioned.

The Agreement and Declaration of Parents

o I, the undersigned, testify that all that are submitted above as true. o I am applying on behalf of the above mentioned student to enroll at this institution. o I understand the Rules and Regulation of the Madrasah and agree to abide by it. o I, in my capacity as the PARENT/GUARDIAN/SPONSOR of the student mentioned

above, hereby undertake to pay the fees as indicated above o I am responsible for the arrangement of the student’s visa. o I hereby agree that:

1. The parents shall not intervene in the operation of the madrasah. Any feedback must be addressed to the mudir in writing.

2. The madrasah will do its utmost to take care of the student’s safety, but is NOT responsible for any mental or physical harm that may befall the student for all time during the stay in the madrasah or away from the madrasah.

3. Punctuality is of high importance. Disciplinary action shall be taken on students returning late to the madrasah.

4. Any item(s) found in possession of the student, which have been ruled impermissible by the madrasah, will be confiscated. It is entirely up to the madrasah to do what is deemed necessary with the confiscated item(s). The parents have no more rights over the item(s).

5. The madrasah will inform the student and may update the parents of the items which have been declared impermissible by the madrasah.

6. The madrasah has the right to expel the student who is found to be unfit, academically or behaviourally, to continue his/her study in the madrasah.

We put our trust in Allah swt. Signature of parent/guardian/sponsor : _______________________________________ Name of parent/guardian/ sponsor : _______________________________________ This application was completed and submitted on (date) ____________________