Course Registration: English Language Holiday Programme

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Applicant Info

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Date Of Birth*

Eg: 12/10/1992

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ID Document*

MyKad/MyKid
Passport
None

ID Number*

Email*

Mobile*

Medical Data

Do you have any allergies?

Any medical conditions that we need to be aware of?

Parent/Legal Guardian Malaysia Info

Name*

Nationality/Country*

Mobile*

Home Phone*

ID Document*

MyKad/MyKid
Passport

ID Number*

Email*

Email Confirm*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment

Kindly make the payment via direct transfer or internet transaction to :

Recipient bank: CIMB Bank Bhd
Recipient name: Epsom College Malaysia Sdn Bhd
A/C No.: 800 1749 320
SWIFT Code : CIBBMYKL

Please quote student's name in full for verification.
Kindly email proof of payment to : tony.lai@epsomcollege.edu.my or nurazlin.razak@epsomcollege.edu.my

Consent*

I have read and agreed to the terms and conditions.

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