Online Application

A. MAKLUMAT PERIBADI / PERSONAL PARTICULARS

Harap lampirkan sekeping gambar anda berukuran saiz paspot. Please attach one passport-sized photo of you.:

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No. KP/ NRIC:*

Jantina/ Gender:*

Nama seperti dalam Kad Pengenalan (Huruf Besar)/ Full Name As in NRIC (Capital letter):*

Alamat Emel/ E-mail Address:*

Tarikh Lahir/ DOB:*

January 2026

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
01	28	29	30	31	1	2	3
02	4	5	6	7	8	9	10
03	11	12	13	14	15	16	17
04	18	19	20	21	22	23	24
05	25	26	27	28	29	30	31
06	1	2	3	4	5	6	7

Status Perkahwinan/ Marital Status:*

Telephone (Rumah)/ (Residence):

No. Tel. Bimbit./ Mobile No:*

Office No./Telefon (Pejabat).:

Pekerjaan / Occupation :*

Pendapatan/ Income:*

Alamat Rumah/ Home Address

Block No.:*

Street Name:*

Unit No. (Omit #):*

Building Name:

Poskod/ Postal Code:*

Alamat Surat-Menyurat (Jika berbeza dengan alamat rumah)/ Mailing Address (If different for home address)

Alamat Surat-Menyurat/ Mailing Address

Block No.:

Street Name:

Unit No. (Omit #):

Building Name:

Poskod/ Postal Code:

B. KELAYAKAN LAIN & KEMAHIRAN PROFESIONAL / OTHER QUALIFICATIONS & PROFESSIONAL COMPETENCIES

Sila beri maklumat tentang kelayakan dan kemahiran profesional yang sesuai dengan permohonan anda. / Please state your professional qualification that is appropriate with your application.:

C. MAKLUMAT PENDIDIKAN / EDUCATION BACKGROUND

Taraf Kelulusan Tertinggi / Highest Qualification:*

Kelayakan Pendidikan Agama/ Islamic Studies Highest Achievement

Institusi/ Institution:*

Tahun Pengajian/ Years of Study (From/):

Tahun Pengajian/ Years of Study (To/Hingga):

Peringkat Kelayakan/ Achievement:*

TINJAUAN AM/ GENERAL SURVEY

Dari manakah anda mendapat maklumat mengenai program IPIP?/ Where did you obtain the information on IPIP programmes?:*

Lain. (Sila Nyatakan)/ Others (Pls state):*

PERHATIAN BAGI SETIAP PEMOHON / DECLARATION

Sila pastikan beberapa perkara berikut sebelum menghantar borang ini. Semua borang yang tidak lengkap tidak akan diproses. / Please ensure that several procedures are correctly executed before sending the application form. Any incomplete forms will not be processed.
Selepas pendaftaran dan pembayaran, peserta atau wakil peserta dianggap telah membaca dan menerima syarat & ketentuan sebagai berikut. / Upon registration and payment of fees, students or their representatives are deemed to have read and accepted the following terms and conditions.
1. Sila isikan keterangan dengan jelas pada setiap ruangan./ Please fill up the information succinctly on every appropriate space.
2. Pastikan setiap ruangan maklumat yang diminta terisi dengan lengkap & jelas. / Please ensure that all the required information is complete and correct.
3. Berikan salinan sijil akademik, transkrip peperiksaan serta sijil-sijil sampingan yang bersesuaian. (untuk pendaftaran program SLPI, DPI sahaja). / Please attach copies of academic certificate, examination results, transcripts as well as relevant certificate if necessary (applicable for SLPI, DPI only)
4. Harap lampirkan sekeping gambar anda berukuran saiz paspot. / Please attach one passport-sized photo with your application.

Pembayaran / Payment

Borang yang lengkap sahaja yang akan diproses sepenuhnya. / Only completed form will be processed fully.
‘Crossed’ cek harus ditulis dengan nama ‘PERGAS’. / ‘Crossed’ cheque shall be written in the name of ‘PERGAS’.
Yuran pendaftaran yang telah dilakukan tidak akan dikembalikan dan tidak boleh dialihkan kepada orang lain. / Registration fee that has been paid will not be returned and cannot be transferred to any person.

Penarikan Diri / Withdrawal

Pelajar yang menarik diri selepas pengajian bermula maka dikenakan atasnya yuran penuh. Ini bermakna pelajar itu wajib melunaskan baki yuran kursus yang tertunggak. Pelajar yang membayar secara bulanan juga tertakluk kepada undang-undang ini. / Students who withdraw from any programme after it commences are liable for the full course fee. Hence, the students who withdraw must pay the balance of the unpaid fees. Students who is paying the course fees monthly are bonded with the rule.
Setiap permohonan penarikan diri perlu dilakukan secara bertulis / Withdrawal of course or programme must be made in writing.

Sila rujuk rajah di bawah berkaitan dengan hal penarikan diri:

Tempoh Penarikan Diri	Peratusan Yuran Dikembalikan
Lebih dari [7] hari sebelum pengajian bermula	100%
Sebelum dan tidak lebih dari [7] hari sebelum kelas bermula	75%
Selepas dan tidak melebihi [7] hari selepas kelas bermula	50%
Lebih dari [7] hari selepas kelas bermula	0%

Please refer to the table below regarding the withdrawal of course or programme:

Time of course withdrawal	Percentage of fees returned
More than 7 days before programme begins	100%
Less than 7 days before programme begins	75%
Less than 7 days after programme begins	50%
More that 7 days after programme begins	0%

I have read and accepted the above PERHATIAN BAGI SETIAP PEMOHON / DECLARATION and noted that this will take immediate effect upon enrolment.