Attention:
- Please fill in section A, B, C, D, E, F, G
- Fill in all information
- Clik Submit / Send button at the end of the form

A. REGISTRATION INFORMATION
APPLICATION FOR SCHOOL*
FOR INTAKE YEAR*
FOR LEVEL FORM/YEAR*
School Session*
PREVIOUS SCHOOL
B. STUDENT'S INFORMATION
Student's Name*
Citizenship
IC No/MyKid/Passport* Eg. 080701075251
Birth Cert. No Eg. Y9000129
Place Of Birth*
Birth Date*
Gender/Race/Religion*
Tel. Mobile* (Parent) Eg. 0123456789
Email (Parent)
Eg. mel@yahoo.com
Tel. Home Eg. 0380001234
Home Address (Line 1)*
Home Address (Line 2)
City*
Postcode*
Illness/Allergy

 Others (Specify)
 
C. FATHER'S INFORMATION
Name*
IC No* Eg. 760103075251
Occupation*
Salary* (RM) Eg. 5500
Employer*
Office Address
Tel. Mobile* Eg. 0123456789
Tel. Home Eg. 0380081234
Tel. Office Fax:
Email
Eg. mel@yahoo.com
D. MOTHER'S INFORMATION
Name*
IC No* Eg. 760103075250
Occupation* Suri Rumah(Klik)
Salary* (RM) Eg. 5500
Employer
Office Address
Tel. Mobile* Eg. 0123456789
Tel. Home Eg. 0380001234
Tel. Office Fax :
Email
Eg. mel@yahoo.com
E. FAMILY'S INFORMATION
  Name School/College/Job Birth Year
1.
2.
3.
4.
5.
6.
7.
8.
F. FOR EMERGENCY CONTACT (Other Than Parent)
 Name*
 Relationship*
 Tel. Mobile* Eg. 0123456789
 Tel. Home Eg. 0380001234
 Tel. Office Eg. 0380001234
 Fax
 Email
Eg. mel@yahoo.com

G. OTHERS
How do you find about KMSS*

I, here with agreed that all information given is correct. Khalifah Model School (Secondary) has the rights to reject without prior notice. Thank you.