Requestor Name *

Requestor Email *

Designation *

Company Name *

Address *

Telephone Number *

Reason For the Request Select... Employment Background Screening Further Study Academic Verification Other — State Reason

Other Remarks *

Candidate Name *

National ID / Passport *

Student ID Number *

Awarded Qualification (Graduated Programme)

Institution Name * Please select MIITUniKL BiSUniKL BMIUniKL IIMUniKL MESTECHUniKL MFIUniKL MIATUniKL MICETUniKL MIDIUniKL MIMETUniKL MITECUniKL MSIUniKL RCMP

Awarding Country

Study Period (Start Year)

Study Period (End Year)

Mode of Study Select... Full-Time Part-Time Online

Information Release Form/Consent Form * Allowed file types: PDF, DOC, DOCX, JPG, PNG

Any Supporting document Select... Yes No