City College of Business Management - CCBM Online Registration Form                                  
PERSONAL DETAILS
 
Fields marked with * are mandatory.
Mr
Mrs
Miss
Name*
Email*
IC/Passport*
Example:- 920521045026
Sex
Male
Female
Date of Birth
Example:- 21-05-1992
Nationality
Contact Address*
City
State  
Postcode  
Tel No*
Mobile  
Fax
 
 
 
Highest Academic Qualification
SPM
UEC/SM3
STPM
Others
 
 
PARENT / GUARDIAN DETAILS
Name of Father/Guardian
 Relationship
Address
City
State
Postcode
Tel No
H/P No
Fax No
 
 
Education Advisor Name / ID (Optional) : 
 
 
Signature *  (Please insert your name)
Submission Date
 
 
 
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