Postgraduate

Management Office, Level 10, Postgraduate and Research Tower, Faculty of Dentistry,
University of Malaya, Tel : +603-79677463; Mobile : 010 8920 888; email : mrbat@um.edu.my

APPLICATION FORM FOR BASIC MEDICAL SCIENCE COURSE
& EXAMINATION

Full Name: …………………….……………………………………………………………………………………………
(in BLOCK LETTERS as appear on your Identity Card)
Identity Card No.:………………………………………….. Organization:…………………………………….
Address (For Course & Examination Notification): Date of Birth :
…………………..……………………………………………………………………………………………………..…………………………………………
…………………………………………………………………………………………………………………………………………….……………………..
Postcode:…………………..Town/state:…………………….Tel. No (Off):……………………………(H/P):……………………………..
Fax. No.:………………………………………….Email:……………………………………………………………………………….…………………
Special diet: Vegetarian Others,Please specify:….…………………………..…………………………………….

Degree or qualifications with dates and name of awarding authority (Please enclose a copy of your degree
and MDC certificate) :
Degree Year University


I would like to register for the (Please tick) :
Programme Fee Date (√)
Basic Medical Sciences Course RM1800 27th Nov 2017 – 8th Dec 2017

Basic Medical Sciences Examination RM700 8th Jan 2018 – 10th Jan 2018

If you have previously entered for BMS, please give the date and description of previous entries:
Date of Course Date of Exam



METHOD OF PAYMENT
Payment can be by Cash/Cheque/Bank draft made payable to ‘Bendahari Universiti Malaya’
Course fee (Including GST 6%) RM1800 ( ) and exam fee RM700 ( ). (Please tick).

Cheque/Bank draft (Made payable to “BENDAHARI UNIVERSITI MALAYA”) Cheque No:…………………
Cash Amount RM:



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CANCELLATION POLICY
The fee for course and exam are non-refundable except if supported by a good reason. All requests for
cancellation are to be made in writing to the BMS Secretariat, one week before the commencement of the
course and exam.
All Candidates entering for the course and examination must support their application with the following
declaration:

I hereby apply to be admitted to the BMS, commencing on:
I have read and understood the course & examination’s regulations and understand the eligibility criterion.
I now confirm that to the best of my knowledge all the information on this form is true.


Signature of candidate: ………………………………………………………………….. Date : ………………………………………..……..



BMS application form checklist:

Is your application complete? Please make sure that you have included the following (please tick):
1 MDC number, plus the original or certified copies of your dental degree and registration document
2 Completed payment form with cheque details for the BMS exam
3 Permanent correct address and telephone number
4 Signed and dated declarations
5 Passport photograph


For Office Use Only

Please return your completed form to:

Basic Medical Science For Dentistry Fee
(Postgraduate Management Office) No. Cheque
Faculty of Dentistry, University of Malaya Bank
50603 Kuala Lumpur Date

Tel : 603 7967 7463 Fax: 603 7967 6473

C://mrbat/14082017