Peraturan-Peraturan Institusi Pendidikan Tinggi Swasta (Penubuhan Institusi Pendidikan Tinggi Swasta dan Cawangan) 2018

Jadual Pertama.

(2)

Permohonan di bawah subperaturan (1) hendaklah disertakan dengan—

(a)

apa-apa dokumen sebagaimana yang ditentukan oleh Ketua Pendaftar; dan

(b)

fi sebagaimana yang dinyatakan dalam Jadual Kedua.

(3)

Fi yang disebut dalam perenggan (2)(b) hendaklah kena dibayar kepada

Ketua Pendaftar.

P.U. (A) 53 3

Keperluan yang ditetapkan 3.

Bagi maksud perenggan 9(c) Akta, keperluan yang ditetapkan adalah seperti yang berikut:

(a)

pemohon itu berkebolehan untuk menyediakan tapak dan premis bagi kegunaan institusi pendidikan tinggi swasta itu;

(b)

pemohon itu mempunyai pengalaman yang bersesuaian atau rekod prestasi yang cemerlang dalam pendidikan;

(c)

pemohon itu berkebolehan untuk menyediakan guru yang berkelayakan dan berpengalaman dalam bidang yang berkaitan bagi institusi pendidikan tinggi swasta itu;

(d)

pemohon itu mempunyai kedudukan kewangan yang kukuh dan berkebolehan untuk menyediakan pengurusan kewangan yang baik bagi institusi pendidikan tinggi swasta itu; dan

(e)

pemohon itu berkebolehan untuk mengendalikan kursus pengajian atau program latihan secara bersendirian atau secara bergabung, bersekutu atau bekerjasama dengan mana-mana institusi pendidikan tinggi swasta atau badan profesional.

Modal terbitan dan berbayar atau dana permulaan syarikat 4.

(1)

Bagi maksud perenggan 12(1)(a) Akta, modal terbitan dan berbayar bagi pemohon itu hendaklah tidak kurang daripada satu juta ringgit.

(2)

Bagi maksud perenggan 12(1A)(a) Akta, dana permulaan bagi pemohon itu hendaklah tidak kurang daripada satu juta ringgit.

P.U. (A) 53 4

Permohonan bagi kelulusan untuk menubuhkan cawangan 5.

(1)

Suatu permohonan bagi kelulusan untuk menubuhkan suatu cawangan di bawah seksyen 18 Akta hendaklah dibuat oleh institusi pendidikan tinggi swasta kepada Ketua Pendaftar dalam Borang B sebagaimana yang dinyatakan dalam

Jadual Pertama.

(2)

Permohonan di bawah subperaturan (1) hendaklah disertakan dengan—

(a)

apa-apa dokumen sebagaimana yang ditentukan oleh Ketua Pendaftar; dan

(b)

fi sebagaimana yang dinyatakan dalam Jadual Kedua.

(3)

Fi yang disebut dalam perenggan (2)(b) hendaklah kena dibayar kepada

Ketua Pendaftar.

Pindaan perakuan pendaftaran 6.

Institusi pendidikan tinggi swasta hendaklah mengemukakan perakuan pendaftaran yang dikeluarkan di bawah subseksyen 24(9) Akta kepada Ketua Pendaftar bagi pindaan dalam tempoh tiga tahun dari tarikh kelulusan untuk menubuhkan suatu cawangan di bawah perenggan 18(6)(a) Akta.

Pembatalan 7.

Peraturan-Peraturan Institusi Pendidikan Tinggi Swasta (Penubuhan) 1997

[P.U. (A) 539/1997] dibatalkan.

Kecualian 8.

Semua permohonan yang dibuat di bawah Peraturan-Peraturan Institusi

Pendidikan

Tinggi

Swasta

(Penubuhan)

1997, yang disebut sebagai

“Peraturan-Peraturan yang dibatalkan” di bawah peraturan ini, yang belum selesai sebaik sebelum tarikh permulaan kuat kuasa Peraturan-Peraturan ini hendaklah, pada tarikh permulaan kuat kuasa Peraturan-Peraturan ini, diuruskan di bawah

Peraturan-Peraturan yang dibatalkan seolah-olah Peraturan-Peraturan ini tidak dibuat.

P.U. (A) 53 5

JADUAL PERTAMA

[Peraturan 2 dan 5]

BORANG A

PERMOHONAN BAGI KELULUSAN UNTUK MENUBUHKAN INSTITUSI PENDIDIKAN

TINGGI SWASTA

Ketua Pendaftar Institusi Pendidikan Tinggi Swasta,

Saya memohon bagi penubuhan—

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Universiti

Kolej Universiti

Kampus cawangan luar negeri

Kolej

Nota:

BAHAGIAN I – Untuk diisi oleh syarikat berhad menurut syer

BAHAGIAN II – Untuk diisi oleh syarikat berhad menurut jaminan

P.U. (A) 53 6

BAHAGIAN I

BUTIR-BUTIR PEMOHON

(SYARIKAT BERHAD MENURUT SYER)

1.

Nama syarikat:

___________________________________________________

___________________________________________________

2.

Status syarikat:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Syarikat awam

Syarikat persendirian

3.

No. Pendaftaran Syarikat:

__________________________________________________

4.

Tarikh pendaftaran:

__________________________________________________

5.

Alamat berdaftar syarikat: __________________________________________________

__________________________________________________

Poskod:

__________________________________________________

Daerah:

__________________________________________________

Negeri:

__________________________________________________

No. Telefon:

__________________________________________________

No. Faks:

__________________________________________________

E-mel:

__________________________________________________

P.U. (A) 53 7

6.

Alamat surat-menyurat syarikat:

__________________________________________________

__________________________________________________

Poskod:

__________________________________________________

Daerah:

__________________________________________________

Negeri:

__________________________________________________

No. Telefon:

__________________________________________________

No. Faks:

__________________________________________________

E-mel:

__________________________________________________

7.

Modal terbitan:

RM __________________________________________________

8.

Modal berbayar:

RM _________________________________________________

P.U. (A) 53 8

9.

Pemegang saham:

Bil. Jenis pemegang saham

(Individu/Syarikat awam/Syarikat persendirian)

Nama penuh dan No. K.P./

No. Pasport atau

Nama syarikat dan

No. Pendaftaran Syarikat

Kewarganegaraan

(jika berkenaan)

Bangsa

(jika berkenaan)

Saham

Nilai

Peratusan

%

Jumlah

(Nota: Jika pemegang saham terdiri daripada suatu syarikat, sila berikan butir-butir terkini semua pemegang saham syarikat itu)

P.U. (A) 53 9

10.

Lembaga pengarah:

Bil.

Nama penuh dan

No. K.P./

No. Pasport

Kewarganegaraan

Bangsa

Profesion

Jawatan dalam syarikat

11.

Kelulusan lain yang telah diberikan kepada pemohon di bawah Akta:

Bil.

Jenis kelulusan

Tarikh kelulusan

No. Rujukan

Catatan

12.

Kepentingan kewangan pemohon dalam perniagaan mana-mana orang atau syarikat lain yang mengadakan atau menguruskan institusi pendidikan tinggi di dalam atau di luar Malaysia:

Bil.

Nama orang/syarikat

(yang mengadakan atau menguruskan institusi pendidikan tinggi)

Nama institusi pendidikan tinggi

Jenis kepentingan kewangan

Nilai

Jumlah

P.U. (A) 53 10

13.

Kepentingan atau hak orang lain dalam perniagaan pemohon termasuk hak untuk menamakan mana-mana pengarah bagi syarikat pemohon:

Bil.

Nama orang/syarikat

(yang mempunyai kepentingan atau hak)

Jenis kepentingan/

hak

Nilai

Jumlah

14.

Urusan perniagaan lain pemohon:

Bil.

Jenis perniagaan

Nama syarikat/

organisasi perniagaan

Jenis penglibatan/

Jawatan

P.U. (A) 53 11

15.

Kepentingan kewangan atau hak orang lain dalam urusan perniagaan lain pemohon:

Bil.

Jenis perniagaan

Nama syarikat/

organisasi perniagaan

Nama orang/

syarikat

(yang mempunyai kepentingan kewangan atau hak)

Jenis kepentingan kewangan/hak

Nilai

Jumlah

BAHAGIAN II

BUTIR-BUTIR PEMOHON

(SYARIKAT BERHAD MENURUT JAMINAN)

1.

Nama syarikat:

___________________________________________________

__________________________________________________

2.

No. Pendaftaran Syarikat:

___________________________________________________

3.

Tarikh pendaftaran:

___________________________________________________

4.

Alamat berdaftar syarikat:

___________________________________________________

___________________________________________________

Poskod:

___________________________________________________

Daerah:

___________________________________________________

P.U. (A) 53 12

Negeri:

___________________________________________________

No. Telefon:

___________________________________________________

No. Faks:

___________________________________________________

E-mel:

___________________________________________________

5.

Alamat surat-menyurat syarikat: ___________________________________________________

___________________________________________________

Poskod:

___________________________________________________

Daerah:

___________________________________________________

Negeri:

___________________________________________________

No. Telefon:

___________________________________________________

No. Faks:

___________________________________________________

E-mel:

___________________________________________________

6.

Anggota:

Bil.

Nama penuh dan No. K.P./

No. Pasport atau

Nama syarikat dan

No. Pendaftaran Syarikat

Alamat tetap/

Alamat berdaftar syarikat

Sumbangan

Jumlah

P.U. (A) 53 13

7.

Lembaga pengarah atau pemegang amanah:

Bil.

Nama penuh dan

No. K.P./No. Pasport

Kewarganegaraan

Bangsa Profesion

Jawatan dalam syarikat

8.

Kelulusan lain yang telah diberikan kepada pemohon di bawah Akta:

Bil.

Jenis kelulusan

Tarikh kelulusan

No. Rujukan

Catatan

9.

Kepentingan kewangan pemohon dalam perniagaan mana-mana orang atau syarikat lain yang mengadakan atau menguruskan institusi pendidikan tinggi di dalam atau di luar Malaysia:

Bil.

Nama orang/syarikat

(yang mengadakan atau menguruskan institusi pendidikan tinggi)

Nama institusi pendidikan tinggi

Jenis kepentingan kewangan

Nilai

Jumlah

P.U. (A) 53 14

10. Kepentingan atau hak orang lain dalam perniagaan pemohon termasuk hak untuk menamakan mana-mana pengarah bagi syarikat pemohon:

Bil.

Nama orang/syarikat

(yang mempunyai kepentingan atau hak)

Jenis kepentingan/

hak

Nilai

Jumlah

11. Urusan perniagaan lain pemohon:

Bil.

Jenis perniagaan

Nama syarikat/

organisasi perniagaan

Jenis penglibatan/

Jawatan

12. Kepentingan kewangan atau hak orang lain dalam urusan perniagaan lain pemohon:

Bil.

Jenis perniagaan

Nama syarikat/

organisasi perniagaan

Nama orang/

syarikat

(yang mempunyai kepentingan kewangan atau hak)

Jenis kepentingan kewangan/

hak

Nilai

Jumlah

P.U. (A) 53 15

BAHAGIAN III

BUTIR-BUTIR INSTITUSI PENDIDIKAN TINGGI SWASTA YANG DICADANGKAN

1.

Tiga nama institusi pendidikan tinggi swasta yang dicadangkan:

Bil.

Bahasa kebangsaan

Bahasa Inggeris 1.

2.

3.

2.

Alamat institusi pendidikan tinggi swasta yang dicadangkan: ___________________________________________________

___________________________________________________

Poskod:

___________________________________________________

Daerah:

___________________________________________________

Negeri:

___________________________________________________

P.U. (A) 53 16

BAHAGIAN IV

KURSUS PENGAJIAN DAN PROGRAM LATIHAN YANG DICADANGKAN

Bil.

Nama kursus pengajian/

program latihan

Bidang

Peringkat

Jenis kursus pengajian

Cara penyampaian

Tempoh kursus

Kelayakan kemasukan

Rakan kongsi kerjasama

(jika berkenaan)

Badan atau institusi yang menganugerahkan

Tahunan

Kursus keseluruhan

BAHAGIAN V

UNJURAN BILANGAN PELAJAR DAN GURU

Bil.

Nama kursus pengajian/program latihan

Bidang

Unjuran bilangan pelajar dan guru

(bagi perancangan lima tahun selepas pendaftaran)

Tahun 1

Tahun 2

Tahun 3

Tahun 4

Tahun 5

Jumlah

(Nota: P: Pelajar, G: Guru)

BAHAGIAN VI

SUMBER KEWANGAN

Bil.

Sumber

Amaun (RM)

Jumlah

17

P.U. (A) 53 18

BAHAGIAN VII

PREMIS DAN KEMUDAHAN

1.

Jenis premis:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Lot kedai

Kampus dibina khas

Kompleks beli belah

Kediaman

Lot pejabat

Lain-lain (sila nyatakan):

_________________________________________________________________________________

2.

Pemunyaan premis:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Premis kepunyaan sendiri

Harga belian premis (jika berkenaan):

__________________________________________________________________________________________

Premis sewa

Amaun sewa: RM ____________________________*sebulan/setahun

Tarikh habis tempoh sewa: _________________________________________________

P.U. (A) 53 19

Nama pemunya premis: _________________________________________________

_________________________________________________

Alamat:

_________________________________________________

_________________________________________________

Poskod:

_________________________________________________

Daerah:

_________________________________________________

Negeri:

_________________________________________________

3.

Luas lantai premis: ___________________________________*meter persegi/kaki persegi

Luas tapak premis: ____________________________________________________ *hektar/ekar

(Nota: *Potong mana-mana yang tidak berkenaan)

4.

Butir-butir bangunan:

Bil.

Nama bangunan

Jenis kegunaan

Jumlah bilangan bilik

5.

Butir-butir kemudahan rekreasi:

Bil.

Jenis kemudahan rekreasi

Jumlah bilangan kemudahan rekreasi

P.U. (A) 53 20

6.

Butir-butir kemudahan lain:

Bil.

Jenis kemudahan

Jumlah bilangan kemudahan

BAHAGIAN VIII

KETUA EKSEKUTIF YANG DICADANGKAN

1.

Nama penuh:___________________________________________________________________________

(Huruf Besar)

2.

*No. K.P./No. Pasport: ___________________________________________________________

(Nota: *Potong mana-mana yang tidak berkenaan)

3.

Kewarganegaraan: ___________________________________________________________

4.

Maklumat mengenai pekerjaan semasa (jika ada):

Jawatan:

___________________________________________________________

Nama majikan:

___________________________________________________________

Gambar ukuran pasport

P.U. (A) 53 21

Alamat majikan: ___________________________________________________________

___________________________________________________________

Poskod:

___________________________________________________________

Daerah: ___________________________________________________________

Negeri:

___________________________________________________________

No. Telefon: ___________________________________________________________

No. Faks: ___________________________________________________________

E-mel:

___________________________________________________________

5.

Kelayakan akademik tertinggi atau kelayakan profesional:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

6.

Pengalaman pekerjaan:

Bil.

Nama dan alamat organisasi

Tahun

Jawatan

Dari

Hingga

P.U. (A) 53 22

BAHAGIAN IX

AKUAN

Saya, __________________________________________________________________________________________

*No. K.P./No. Pasport _______________________________________________________________________

bagi pihak ____________________________________________________________________________________

(nama syarikat) dengan sesungguhnya mengaku bahawa—

Ketua Pendaftar mempunyai hak untuk mengambil apa-apa tindakan yang perlu sebagaimana yang diperuntukkan di bawah Akta;

(b)

sepanjang pengetahuan saya, semua anggota pengurusan syarikat termasuk mana-mana pengarah, pengurus, setiausaha atau mana-mana orang yang memegang jawatan seumpamanya yang lain dalam syarikat tidak mempunyai sabitan jenayah; dan

(c)

sepanjang pengetahuan saya, semua anggota pengurusan syarikat tidak diisytiharkan sebagai bankrap.

Ditandatangani dan diakui oleh,

Cap Rasmi

___________________________________

_______________________________

(Tandatangan)

(Tarikh)

Nama Penuh:

_______________________________________________________________________

*No. K.P./No. Pasport: _______________________________________________________________________

Jawatan:

_______________________________________________________________________

(Nota: *Potong mana-mana yang tidak berkenaan)

P.U. (A) 53 23

BORANG B

PERMOHONAN BAGI KELULUSAN UNTUK MENUBUHKAN CAWANGAN INSTITUSI

PENDIDIKAN TINGGI SWASTA

Ketua Pendaftar Institusi Pendidikan Tinggi Swasta,

Saya memohon bagi penubuhan suatu cawangan—

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Universiti

Kolej Universiti

Kolej

Nota:

BAHAGIAN II – Untuk diisi oleh syarikat berhad menurut syer

BAHAGIAN III –Untuk diisi oleh syarikat berhad menurut jaminan

P.U. (A) 53 24

BAHAGIAN I

BUTIR-BUTIR INSTITUSI PENDIDIKAN TINGGI SWASTA

1.

Nama institusi pendidikan tinggi swasta:

__________________________________________________________________________________________

2.

Jenis institusi pendidikan tinggi swasta:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Universiti

Kolej Universiti

Kolej

3.

Tarikh penubuhan: _____________________________________________________

4.

Tempoh kesahan pendaftaran: ____________________ hingga ________________________

5.

Alamat institusi pendidikan tinggi swasta:

____________________________________________________

____________________________________________________

Poskod:

____________________________________________________

Daerah:

____________________________________________________

Negeri:

____________________________________________________

6.

Penarafan kualiti kebangsaan terkini: _______________________________________________

P.U. (A) 53 25

7.

Perakuan kualiti pengajaran dan pembelajaran:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

ISO

No. Perakuan:

_______________________________________

Sah sehingga: _______________________________________

Lain-lain (sila nyatakan)

_______________________________________

No. Perakuan:

_______________________________________

Sah sehingga: _______________________________________

8.

Butir-butir pelajar:

Jumlah bilangan pelajar:

___________________

Jumlah bilangan pelajar antarabangsa:

___________________

Jumlah bilangan pelajar yang disediakan penginapan: ___________________

9.

Bilangan guru:

Bil.

Kelayakan tertinggi

Bilangan guru

Tetap

Sementara 1.

Ijazah kedoktoran

2.

Ijazah sarjana

3.

Ijazah sarjana muda

4.

Diploma

5.

Sijil

P.U. (A) 53 26

10. Lembaga pengelola:

11. Senarai kursus pengajian atau program latihan:

Bil.

Kursus pengajian/

Program latihan

Jenis kursus pengajian

Tempoh kesahan

Nombor rujukan perakuan

Tarikh perakuan

Tarikh kelulusan

Tarikh habis tempoh

12. Butir-butir bangunan:

Bil.

Nama bangunan

Jenis kegunaan

Jumlah bilangan bilik

Bil.

Nama penuh

Jawatan

Kelayakan tertinggi

Bilangan tahun pengalaman dalam institusi pendidikan tinggi

P.U. (A) 53 27

13. Butir-butir kemudahan rekreasi:

Bil.

Jenis kemudahan rekreasi

Jumlah bilangan kemudahan rekreasi

14. Butir-butir kemudahan lain:

Bil.

Jenis kemudahan

Jumlah bilangan kemudahan

15. Bantuan kewangan pelajar:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Bil.

Jenis bantuan kewangan pelajar

Ya

Tidak 1.

Tabung Pendidikan Tinggi Nasional

2.

Bantuan kewangan dalaman institusi

3.

Biasiswa Kerajaan

4.

Lain-lain (sila nyatakan)

P.U. (A) 53 28

16. Pengurusan pelajar antarabangsa:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Wujudnya pejabat pelajar antarabangsa

Ya Tidak

Wujudnya pegawai perhubungan pelajar antarabangsa

Ya Tidak

Wujudnya sistem atau prosedur bagi pelajar antarabangsa

Ya Tidak

BAHAGIAN II

BUTIR-BUTIR SYARIKAT

(SYARIKAT BERHAD MENURUT SYER)

1.

Nama syarikat:

________________________________________________________

________________________________________________________

2.

Status syarikat:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Syarikat awam

Syarikat persendirian

3.

No. Pendaftaran Syarikat:

______________________________________________

4.

Tarikh pendaftaran:

______________________________________________

P.U. (A) 53 29

5.

Alamat berdaftar syarikat:

______________________________________________

______________________________________________

Poskod:

______________________________________________

Daerah:

______________________________________________

Negeri:

______________________________________________

No. Telefon:

______________________________________________

No. Faks:

______________________________________________

E-mel:

______________________________________________

6.

Alamat surat-menyurat syarikat: ______________________________________________

______________________________________________

Poskod:

______________________________________________

Daerah:

______________________________________________

Negeri:

______________________________________________

No. Telefon:

______________________________________________

No. Faks:

______________________________________________

E-mel:

______________________________________________

7.

Modal terbitan:

RM ______________________________________________

8.

Modal berbayar:

RM ______________________________________________

P.U. (A) 53 30

9.

Pemegang saham:

Bil.

Jenis pemegang saham

(Individu/Syarikat awam/Syarikat persendirian)

Nama penuh dan No. K.P./

No. Pasport atau

Nama syarikat dan No.

Pendaftaran Syarikat

Kewarganegaraan

(jika berkenaan)

Bangsa

(jika berkenaan)

Saham

Nilai

Peratusan

%

Jumlah

(Nota: Jika pemegang saham terdiri daripada suatu syarikat, sila berikan butir-butir terkini semua pemegang saham syarikat itu)

10.

Lembaga pengarah:

Bil.

Nama penuh dan

No. K.P./

No. Pasport

Kewarganegaraan

Bangsa Profesion

Jawatan dalam syarikat

11.

Kelulusan lain yang telah diberikan kepada pemohon di bawah Akta:

Bil.

Jenis kelulusan

Tarikh kelulusan

No. Rujukan

Catatan

12.

Kepentingan kewangan pemohon dalam perniagaan mana-mana orang atau syarikat lain yang mengadakan atau menguruskan institusi pendidikan tinggi di dalam atau di luar Malaysia:

Bil.

Nama orang/syarikat

(yang mengadakan atau menguruskan institusi pendidikan tinggi)

Nama institusi pendidikan tinggi

Jenis kepentingan kewangan

Nilai

Jumlah

31

P.U. (A) 53 32

13.

Kepentingan atau hak orang lain dalam perniagaan pemohon termasuk hak untuk menamakan mana-mana pengarah bagi syarikat pemohon:

Bil.

Nama orang/syarikat

(yang mempunyai kepentingan atau hak)

Jenis kepentingan/

hak

Nilai

Jumlah

14.

Urusan perniagaan lain pemohon:

Bil.

Jenis perniagaan

Nama syarikat/

organisasi perniagaan

Jenis penglibatan/

Jawatan

P.U. (A) 53 33

15.

Kepentingan kewangan atau hak orang lain dalam urusan perniagaan lain pemohon:

Bil.

Jenis perniagaan

Nama syarikat/

organisasi perniagaan

Nama orang/

syarikat

(yang mempunyai kepentingan kewangan atau hak)

Jenis kepentingan kewangan/

hak

Nilai

Jumlah

BAHAGIAN III

BUTIR-BUTIR SYARIKAT

(SYARIKAT BERHAD MENURUT JAMINAN)

1.

Nama syarikat:

________________________________________________

________________________________________________

2.

No. Pendaftaran Syarikat: ________________________________________________

3.

Tarikh pendaftaran:

________________________________________________

4.

Alamat berdaftar syarikat:

________________________________________________

________________________________________________

Poskod:

________________________________________________

Daerah:

________________________________________________

Negeri:

_______________________________________________

P.U. (A) 53 34

No. Telefon:

_______________________________________________

No. Faks:

_______________________________________________

E-mel:

_______________________________________________

5.

Alamat surat-menyurat syarikat: _______________________________________________

_______________________________________________

Poskod:

_______________________________________________

Daerah:

_______________________________________________

Negeri:

_______________________________________________

No. Telefon:

_______________________________________________

No. Faks:

_______________________________________________

E-mel:

_______________________________________________

6.

Anggota:

Bil.

Nama penuh dan No. K.P./

No. Pasport atau

Nama syarikat dan No.

Pendaftaran Syarikat

Alamat tetap/Alamat berdaftar syarikat

Sumbangan

Jumlah

P.U. (A) 53 35

7.

Lembaga pengarah atau pemegang amanah:

Bil.

Nama penuh dan

No. K.P./No. Pasport

Kewarganegaraan

Bangsa Profesion

Jawatan dalam syarikat

8.

Kelulusan lain yang telah diberikan kepada pemohon di bawah Akta:

Bil.

Jenis kelulusan

Tarikh kelulusan

No. Rujukan

Catatan

9.

Kepentingan kewangan pemohon dalam perniagaan mana-mana orang atau syarikat lain yang mengadakan atau menguruskan institusi pendidikan tinggi di dalam atau di luar Malaysia:

Bil.

Nama orang/syarikat

(yang mengadakan atau menguruskan institusi pendidikan tinggi)

Nama institusi pendidikan tinggi

Jenis kepentingan kewangan

Nilai

Jumlah

P.U. (A) 53 36

10.

Kepentingan atau hak orang lain dalam perniagaan pemohon termasuk hak untuk menamakan mana-mana pengarah bagi syarikat pemohon:

Bil.

Nama orang/syarikat

(yang mempunyai kepentingan atau hak)

Jenis kepentingan/

hak

Nilai

Jumlah

11.

Urusan perniagaan lain pemohon:

Bil.

Jenis perniagaan

Nama syarikat/

organisasi perniagaan

Jenis penglibatan/

Jawatan

12.

Kepentingan kewangan atau hak orang lain dalam urusan perniagaan lain pemohon:

Bil.

Jenis perniagaan

Nama syarikat/

organisasi perniagaan

Nama orang/syarikat

(yang mempunyai kepentingan atau hak)

Jenis kepentingan kewangan/

hak

Nilai

Jumlah

P.U. (A) 53 37

BAHAGIAN IV

BUTIR-BUTIR CAWANGAN INSTITUSI PENDIDIKAN TINGGI SWASTA

YANG DICADANGKAN

1.

Nama cawangan yang dicadangkan:

Bil.

Bahasa kebangsaan

Bahasa Inggeris

2.

Alamat cawangan yang dicadangkan: _____________________________________________

_____________________________________________

Poskod: _____________________________________________

Daerah:

_____________________________________________

Negeri:

_____________________________________________

3.

Jurusan kursus yang ditawarkan:

____________________________________________

____________________________________________

4.

Cawangan sedia ada (jika ada):

Bil.

Nama cawangan

Alamat

Jurusan kursus yang ditawarkan

P.U. (A) 53 38

BAHAGIAN V

KURSUS PENGAJIAN DAN PROGRAM LATIHAN YANG DICADANGKAN

Bil.

Nama kursus pengajian/

program latihan

Bidang

Peringkat

Jenis kursus pengajian

Cara penyampaian

Tempoh kursus

Kelayakan kemasukan

Rakan kongsi kerjasama

(jika berkenaan)

Badan atau institusi yang menganugerahkan

Tahunan

Kursus keseluruhan

39

BAHAGIAN VI

UNJURAN BILANGAN PELAJAR DAN GURU

Bil.

Nama kursus pengajian/Program latihan

Bidang

Unjuran bilangan pelajar dan guru

(bagi perancangan lima tahun selepas pendaftaran)

Tahun 1

Tahun 2

Tahun 3

Tahun 4

Tahun 5

Jumlah

(Nota: P: Pelajar, G: Guru)

BAHAGIAN VII

SUMBER KEWANGAN

Bil.

Sumber

Amaun (RM)

Jumlah

40

BAHAGIAN VIII

PREMIS DAN KEMUDAHAN

1.

Jenis premis:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Lot kedai

Kampus yang dibina

Kompleks beli belah

Kediaman

Lot pejabat

Lain-lain (sila nyatakan):

________________________________________________________________________________

2.

Pemunyaan premis:

(Nota: Sila tanda (√) mana-mana yang berkenaan)

Premis kepunyaan sendiri

Harga belian premis (jika berkenaan):

__________________________________________________________________________________________

Premis sewa

Amaun sewa: RM ________________________________________________ *sebulan/setahun

Tarikh habis tempoh sewa: _________________________________________________

41

Nama pemunya premis: _________________________________________________

Alamat:

_________________________________________________

_________________________________________________

Poskod:

_________________________________________________

Daerah:

_________________________________________________

Negeri:

_________________________________________________

3.

Luas lantai premis: ___________________________________*meter persegi/kaki persegi

Luas tapak premis: ____________________________________________________ *hektar/ekar

(Nota: *Potong mana-mana yang tidak berkenaan)

4.

Butir-butir bangunan:

Bil.

Nama bangunan

Jenis kegunaan

Jumlah bilangan bilik

5.

Butir-butir kemudahan rekreasi:

Bil.

Jenis kemudahan rekreasi

Jumlah bilangan kemudahan rekreasi

42

6.

Butir-butir kemudahan lain:

Bil.

Jenis kemudahan

Jumlah bilangan kemudahan

BAHAGIAN IX

KETUA CAWANGAN YANG DICADANGKAN

1.

Nama penuh: __________________________________________________________________________

(Huruf Besar)

2.

*No. K.P./No. Pasport: ___________________________________________________________

(Nota: *Potong mana-mana yang tidak berkenaan)

3.

Kewarganegaraan: ___________________________________________________________

4.

Maklumat mengenai pekerjaan semasa (jika ada):

Jawatan:

___________________________________________________________

Nama majikan:

___________________________________________________________

Gambar ukuran pasport

43

Alamat majikan: __________________________________________________________

__________________________________________________________

Poskod:

__________________________________________________________

Daerah: __________________________________________________________

Negeri:

__________________________________________________________

No. Telefon: __________________________________________________________

No. Faks: __________________________________________________________

E-mel:

__________________________________________________________

5.

Kelayakan akademik tertinggi atau kelayakan profesional:

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

6.

Pengalaman pekerjaan:

Bil.

Nama dan alamat organisasi

Tahun

Jawatan

Dari

Hingga

44

BAHAGIAN X

AKUAN

Saya, __________________________________________________________________________________________

*No. K.P./No. Pasport _______________________________________________________________________

Ketua Eksekutif______________________________________________________________________________

(nama institusi pendidikan tinggi swasta) dengan sesungguhnya mengaku bahawa—

Ketua Pendaftar mempunyai hak untuk mengambil apa-apa tindakan yang perlu sebagaimana yang diperuntukkan di bawah Akta;

(b)

sepanjang pengetahuan saya, semua anggota pengurusan syarikat termasuk mana-mana pengarah, pengurus, setiausaha atau mana-mana orang yang memegang jawatan seumpamanya yang lain dalam syarikat, serta semua kakitangan dan guru institusi pendidikan tinggi swasta tidak mempunyai sabitan jenayah; dan

(c)

sepanjang pengetahuan saya, semua anggota pengurusan syarikat tidak diisytiharkan sebagai bankrap.

Ditandatangani dan diakui oleh,

Cap Rasmi

___________________________________

_______________________________

(Tandatangan)

(Tarikh)

Nama Penuh:

_______________________________________________________________________

*No. K.P./No. Pasport: _______________________________________________________________________

45

(Nota: *Potong mana-mana yang tidak berkenaan)

JADUAL KEDUA

[Subperaturan 2(2) dan 5(2)]

FI

Bil.

Perkara

1.

Permohonan bagi kelulusan untuk menubuhkan:

(a)

Universiti 2000.00

(b)

Kolej Universiti 2000.00

(c)

Kampus cawangan luar negeri 2000.00

(d)

Kolej 500.00

2.

Permohonan bagi kelulusan untuk menubuhkan suatu cawangan:

(a)

Universiti 2000.00

(b)

Kolej Universiti 2000.00

(c)

Kolej 500.00

Dibuat 19 Februari 2018

[KPT.U.

DATO' SERI IDRIS BIN JUSOH

Menteri Pendidikan Tinggi

46

PRIVATE HIGHER EDUCATIONAL INSTITUTIONS ACT 1996

IN exercise of the powers conferred by section 88

of the

Private Higher Educational Institutions Act 1996 [Act 555], the Minister makes the following regulations:

Citation and commencement 1.

(1)

These regulations may be cited as the Private Higher Educational

Institutions (Establishment of Private Higher Educational Institution and

Branch) Regulations 2018.

Application for approval to establish private higher educational institution 2.

(1)

An application for approval to establish a private higher educational institution under section 6 of the Act shall be made by an applicant to the

Registrar General in Form A as specified in the First Schedule.

(2)

The application under subregulation (1) shall be accompanied by—

(a)

any document as determined by the Registrar General; and

(b)

the fee as specified in the Second Schedule.

(3)

The fee referred to in paragraph (2)(b) shall be payable to the

Registrar General.

47

Prescribed requirements 3.

For the purpose of paragraph 9(c) of the Act, the prescribed requirements are as follows:

(a)

the applicant is capable of providing the site and premises for the use of the private higher educational institution;

(b)

the applicant has an appropriate experience or excellent performance record in education;

(c)

the applicant is capable of providing qualified and experienced teachers in the relevant fields for the private higher educational institution;

(d)

the applicant has a strong financial position and is capable of providing good financial management for the private higher educational institution;

and

(e)

the applicant is capable of conducting courses of study or training programmes individually or in affiliation, association or collaboration with any higher educational institutions or professional bodies.

Issued and paid up capital or initial fund of company 4.

(1)

For the purpose of paragraph 12(1)(a) of the Act, the issued and paid up capital of the applicant shall not be less than one million ringgit.

(2)

For the purpose of paragraph 12(1A)(a) of the Act, the initial fund of the applicant shall not be less than one million ringgit.

48

Application for approval to establish branch 5.

(1)

An application for approval to establish a branch under section 18 of the Act shall be made by a private higher educational institution to the

Registrar General in Form B as specified in the First Schedule.

(2)

The application under subregulation (1) shall be accompanied by—

(a)

any document as determined by the Registrar General; and

(b)

the fee as specified in the Second Schedule.

(3)

The fee referred to in paragraph (2)(b) shall be payable to the

Registrar General.

Amendment of certificate of registration 6.

The private higher educational institution shall submit the certificate of registration issued under subsection 24(9) of the Act to the Registrar General for amendment within three years from the date of approval to establish a branch under paragraph 18(6)(a) of the Act.

Revocation 7.

The Private Higher Educational Institutions (Establishment) Regulations 1997

[P.U. (A) 539/1997] are revoked.

Savings 8.

All applications made under the

Private

Higher

Educational

Institutions (Establishment) Regulations 1997, which are referred to as the

“revoked Regulations” under this regulation, which are pending immediately before the date of coming into operation of these Regulations shall, on the date of coming into operation of these Regulations, be dealt with under the revoked Regulations as if these Regulations have not been made.

49

FIRST SCHEDULE

[Regulations 2 and 5]

FORM A

APPLICATION FOR APPROVAL TO ESTABLISH PRIVATE HIGHER

Registrar General of Private Higher Educational Institutions,

I seek to apply for the establishment of—

(Note: Please tick (√) whichever is applicable)

University

University College

Foreign branch campus

College

Note:

PART I - To be filled in by a company limited by shares

PART II - To be filled in by a company limited by guarantee

50

PART I

PARTICULARS OF APPLICANT

(COMPANY LIMITED BY SHARES)

1.

Name of company:

__________________________________________________

__________________________________________________

2.

Status of company:

(Note: Please tick (√) whichever is applicable)

Public company

Private company

3.

Company Registration No.: ____________________________________________________

4.

Date of registration:

____________________________________________________

5.

Registered address of company: ____________________________________________________

____________________________________________________

Postcode:

____________________________________________________

District:

____________________________________________________

State:

____________________________________________________

Telephone No.:

____________________________________________________

Fax No.:

____________________________________________________

E-mail:

____________________________________________________

51

6.

Correspondence address of company: ______________________________________________

______________________________________________

Postcode:

______________________________________________

District:

______________________________________________

State:

______________________________________________

Telephone No.:

______________________________________________

Fax No.:

______________________________________________

E-mail:

______________________________________________

7.

Issued capital:

RM ______________________________________________

8.

Paid up capital:

RM ______________________________________________

52

9.

Shareholder:

Type of shareholder

(Individual/Public company/Private company)

Full name and I.C. No./

Passport No. or

Company name and

Company Registration No.

Citizenship

(if applicable)

Race

(if applicable)

Share

Value

Percentage

%

Total

(Note: If the shareholder comprises of a company, please provide the latest particulars of all shareholders of the company)

53

10. Board of directors:

Full name and

I.C. No./Passport No.

Citizenship

Race Profession

Designation in company

11. Other approval that has been granted to the applicant under the Act:

Type of approval

Date of approval

Reference No.

Remark

12. The applicant’s financial interest in the business of any other person or company that provides or manages a higher educational institution within or outside Malaysia:

Name of person/company

(that provides or manages higher educational institution)

Name of higher educational institution

Types of financial interest

Value

Total

54

13. Other person’s interests or rights in the applicant’s business including the right to nominate any director of the applicant’s company:

Name of person/company

(that has interest or right)

Type of interest/right

Value

Total

14. The applicant’s other business concerns:

Type of business

Name of company/business organization

Type of involvement/

Designation

55

15. Other person’s financial interests or rights in the applicant’s other business concerns:

Type of business

Name of company/

business organization

Name of person/

company

(that has financial interest or right)

Type of financial interest/right

Value

Total

PART II

PARTICULARS OF APPLICANT

(COMPANY LIMITED BY GUARANTEE)

1.

Name of company:

______________________________________________

______________________________________________

2.

Company Registration No.:

______________________________________________

3.

Date of registration:

______________________________________________

4.

Registered address of company:

______________________________________________

______________________________________________

Postcode:

______________________________________________

District:

______________________________________________

56

State:

______________________________________________

Telephone No.:

______________________________________________

Fax No.:

______________________________________________

E-mail:

______________________________________________

5.

Correspondence address of company: ______________________________________________

______________________________________________

Postcode:

______________________________________________

District:

______________________________________________

State:

______________________________________________

Telephone No.:

______________________________________________

Fax No.:

______________________________________________

E-mail:

______________________________________________

6.

Member:

Full name and I.C. No./

Passport No. or

Company name and

Company Registration No.

Permanent address/

Registered address of company

Contribution

Total

57

7.

Board of directors or trustee:

Full name and

I.C. No./Passport No.

Citizenship

Race Profession

Designation in company

8.

Other approval that has been granted to the applicant under the Act:

Type of approval

Date of approval

Reference No.

Remark

9.

The applicant’s financial interest in the business of any other person or company that provides or manages a higher educational institution within or outside Malaysia:

Name of person/company

(that provides or manages higher educational institution)

Name of higher educational institution

Types of financial interest

Value

Total

58

10. Other person’s interests or rights in the applicant’s business including the right to nominate any director of the applicant’s company:

Name of person/company

(that has interest or right)

Type of interest/right

Value

Total

11. The applicant’s other business concerns:

Type of business

Name of company/

business organization

Type of involvement/

Designation

12. Other person’s financial interests or rights in the applicant’s other business concerns:

Type of business

Name of company/

business organization

Name of person/

company

(that has financial interest or right)

Type of financial interest/right

Value

Total

59

PART III

PARTICULARS OF PROPOSED PRIVATE HIGHER EDUCATIONAL INSTITUTION

1.

Three proposed names of private higher educational institution:

National language

English language 1.

2.

3.

2.

Proposed address of private higher educational institution:

_____________________________________________________

_____________________________________________________

Postcode:

_____________________________________________________

District:

_____________________________________________________

State:

_____________________________________________________

60

PART IV

PROPOSED COURSE OF STUDY AND TRAINING PROGRAMME

Name of course of study/

training programme

Field Level

Type of course of study

Mode of delivery

Course duration

Entry qualifications

Collaborative partner

(if applicable)

Awarding body or institution

Yearly

Overall course

61

PART V

PROJECTED NUMBER OF STUDENTS AND TEACHERS

Name of course of study/

training programme

Field

Projected number of students and teachers

(for five year planning after registration)

Year 1

Year 2

Year 3

Year 4

Year 5

STSTSTSTST

Total

(Note: S: Student, T: Teacher)

PART VI

FINANCIAL SOURCES

Source

Amount (RM)

Total

P.U. (A) 53 62

PART VII

PREMISES AND FACILITIES

1.

Type of premises:

(Note: Please tick (√) whichever is applicable)

Shop lot

Purpose-built campus

Shopping complex

Residence

Office lot

Others (please specify):

________________________________________________________________________________

2.

Ownership of premises:

(Note: Please tick (√) whichever is applicable)

Self-owned premises

Purchase price of premises (if applicable):

__________________________________________________________________________________________

Rented premises

Rental amount: RM _____________________________per *month/year

Date of expiry of rental period: _________________________________________________

P.U. (A) 53 63

Name of owner of premises: _________________________________________________

_________________________________________________

Address:

_________________________________________________

_________________________________________________

Postcode:

_________________________________________________

District:

_________________________________________________

State:

_________________________________________________

3.

Floor area of premises: ________________________________ *square metre/square feet

Site area of premises: ________________________________________________ *hectare/acre

(Note: *Delete whichever is not applicable)

4.

Particulars of building:

Name of building

Type of use

Total number of rooms

5.

Particulars of recreational facilities:

Type of recreational facilities

Total number of recreational facilities

P.U. (A) 53 64

6.

Particulars of other facilities:

Type of facilities

Total number of the facilities

PART VIII

PROPOSED CHIEF EXECUTIVE

1.

Full name: _____________________________________________________________________________

(Capital Letters)

2.

*I.C. No./Passport No.: ___________________________________________________________

(Note: *Delete whichever is not applicable)

3.

Citizenship: ___________________________________________________________

4.

Information on current employment (if any):

Designation:

____________________________________________________________

Name of employer: ____________________________________________________________

Passport size photograph

P.U. (A) 53 65

Address of employer: ___________________________________________________________

___________________________________________________________

Postcode: ___________________________________________________________

District: ___________________________________________________________

State:

___________________________________________________________

Telephone No.: ___________________________________________________________

Fax No.: ___________________________________________________________

E-mail:

___________________________________________________________

5.

Highest academic qualification or professional qualification:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

6.

Employment experience:

Name and address of organization

Year

Designation

From

To

P.U. (A) 53 66

PART IX

DECLARATION

I, ______________________________________________________________________________________________

*I.C. No./Passport No. _______________________________________________________________________

on behalf of __________________________________________________________________________________

(name of company) do solemnly declare that—

(b)

to the best of my knowledge, all members of the management of the company including any director, manager, secretary or any person holding other similar designation in the company have no criminal conviction; and

(c)

to the best of my knowledge, all members of the management of the company are not declared as bankrupts.

Signed and declared by,

Official Stamp

___________________________________

________________________

(Signature)

(Date)

Full Name: ______________________________________________________________________

*I.C. No./Passport No.: ______________________________________________________________________

Designation:

______________________________________________________________________

(Note: *Delete whichever is not applicable)

P.U. (A) 53 67

FORM B

APPLICATION FOR APPROVAL TO ESTABLISH BRANCH OF PRIVATE HIGHER

Registrar General of Private Higher Educational Institutions,

I seek to apply for the establishment of a branch of—

(Note: Please tick (√) whichever is applicable)

University

University College

College

Note:

PART II - To be filled in by a company limited by shares

PART III - To be filled in by a company limited by guarantee

P.U. (A) 53 68

PART I

PARTICULARS OF PRIVATE HIGHER EDUCATIONAL INSTITUTION

1.

Name of private higher educational institution:

__________________________________________________________________________________________

2.

Type of private higher educational institution:

(Note: Please tick (√) whichever is applicable)

University

University College

College

3.

Date of establishment: _____________________________________________________

4.

Validity period of registration: ________________________ to _________________________

5.

Address of private higher educational institution:

_______________________________________________________

_______________________________________________________

Postcode:

_______________________________________________________

District:

_______________________________________________________

State:

_______________________________________________________

6.

Latest national quality rating: ________________________________________________________

P.U. (A) 53 69

7.

Teaching and learning quality certification:

(Note: Please tick (√) whichever is applicable)

ISO

Certification No.: _______________________________________

Valid until: _______________________________________

Others (please specify)

_______________________________________

Certification No.: _______________________________________

Valid until: _______________________________________

8.

Particulars of students:

Total number of students:

______________

Total number of international students:

______________

Total number of students who are provided with accommodation: ______________

9.

Number of teachers:

Highest qualification

Number of teachers

Permanent

Temporary 1.

Doctorate degree

2.

Master degree

3.

Bachelor degree

4.

Diploma

5.

Certificate

P.U. (A) 53 70

10.

Board of governance:

11.

List of course of study or training programme:

Course of study/

Training programme

Type of course of study

Validity period

Accreditation reference number

Accreditation date

Approval date

Expiry date

12.

Particulars of building:

Name of building

Type of use

Total number of rooms

Full Name

Designation

Highest qualification

Years of experience in higher education institution

P.U. (A) 53 71

13.

Particulars of recreational facilities:

Type of recreational facilities

Total number of recreational facilities

14.

Particulars of other facilities:

Type of facilities

Total number of facilities

15.

Student financial aid:

(Note: Please tick (√) whichever is applicable)

Type of student financial aid

Yes

No 1.

Tabung Pendidikan Tinggi Nasional

2.

Institution internal financial aids

3.

Government scholarship

4.

Others (please specify)

P.U. (A) 53 72

16.

International student management:

(Note: Please tick (√) whichever is applicable)

Existence of international student office

Yes No

Existence of international student liaison officer

Yes No

Existence of system or procedure for international students

Yes No

PART II

PARTICULARS OF COMPANY

(COMPANY LIMITED BY SHARES)

1.

Name of company:

______________________________________________

______________________________________________

2.

Status of company:

(Note: Please tick (√) whichever is applicable)

Public company

Private company

3.

Company Registration No.: ______________________________________________

4.

Date of registration:

______________________________________________

P.U. (A) 53 73

5.

Registered address of company: ______________________________________________

______________________________________________

Postcode:

______________________________________________

District:

______________________________________________

State:

______________________________________________

Telephone No.:

______________________________________________

Fax No.:

______________________________________________

E-mail:

______________________________________________

6.

Correspondence address of company: ______________________________________________

______________________________________________

Postcode:

______________________________________________

District:

______________________________________________

State:

______________________________________________

Telephone No.:

______________________________________________

Fax No.:

______________________________________________

E-mail:

______________________________________________

7.

Issued capital:

RM ______________________________________________

8.

Paid up capital:

RM ______________________________________________

P.U. (A) 53 74

9.

Shareholder:

Type of shareholder

(Individual/Public company/Private company)

Full name and I.C. No./

Passport No. or

Company name and

Company Registration No.

Citizenship

(if applicable)

Race

(if applicable)

Share

Value

Percentage

%

Total

(Note: If the shareholder comprises of a company, please provide the latest particulars of all shareholders of the company)

75

10. Board of directors:

Full name and

I.C. No./Passport No.

Citizenship

Race Profession

Designation in company

11. Other approval that has been granted to the applicant under the Act:

Type of approval

Date of approval

Reference No.

Remark

12. The applicant’s financial interest in the business of any other person or company that provides or manages a higher educational institution within or outside Malaysia:

Name of person/company

(that provides or manages higher educational institution)

Name of higher educational institution

Types of financial interest

Value

Total

76

13. Other person’s interests or rights in the applicant’s business including the right to nominate any director of the applicant’s company:

Name of person/company

(that has interest or right)

Type of interest/right

Value

Total

14. The applicant’s other business concerns:

Type of business

Name of company/business organization

Type of involvement/

Designation

77

15. Other person’s financial interests or rights in the applicant’s other business concerns:

Type of business

Name of company/

business organization

Name of person/

company

(that has financial interest or right)

Type of financial interest/right

Value

Total

PART III

PARTICULARS OF COMPANY

(COMPANY LIMITED BY GUARANTEE)

1.

Name of company:

______________________________________________

______________________________________________

2.

Company Registration No.:

______________________________________________

3.

Date of registration:

______________________________________________

4.

Registered address of company:

______________________________________________

______________________________________________

Postcode:

______________________________________________

District:

______________________________________________

78

State:

______________________________________________

Telephone No.:

______________________________________________

Fax No.:

______________________________________________

E-mail:

______________________________________________

5.

Correspondence address of company: ______________________________________________

______________________________________________

Postcode:

______________________________________________

District:

______________________________________________

State:

______________________________________________

Telephone No.:

______________________________________________

Fax No.:

______________________________________________

E-mail:

______________________________________________

6.

Member:

Full name and I.C. No./

Passport No. or

Company name and

Company Registration No.

Permanent address/

Registered address of company

Contribution

Total

79

7.

Board of directors or trustee:

Full name and

I.C. No./Passport No.

Citizenship

Race Profession

Designation in company

8.

Other approval that has been granted to the applicant under the Act:

Type of approval

Date of approval

Reference No.

Remark

9.

The applicant’s financial interest in the business of any other person or company that provides or manages a higher educational institution within or outside Malaysia:

Name of person/company

(that provides or manages higher educational institution)

Name of higher educational institution

Types of financial interest

Value

Total

80

10. Other person’s interests or rights in the applicant’s business including the right to nominate any director of the applicant’s company:

Name of person/company

(that has interest or right)

Type of interest/right

Value

Total

11. The applicant’s other business concerns:

Type of business

Name of company/business organization

Type of involvement/

Designation

12. Other person’s financial interests or rights in the applicant’s other business concerns:

Type of business

Name of company/

business organization

Name of person/

company

(that has interest or right)

Type of financial interest/right

Value

Total

81

PART IV

PARTICULARS OF PROPOSED BRANCH OF PRIVATE HIGHER

1.

Proposed name of branch:

National language

English language

2.

Proposed address of branch:

____________________________________________

____________________________________________

Postcode:

____________________________________________

District:

____________________________________________

State:

____________________________________________

3.

Niche of course offered:

____________________________________________

____________________________________________

4.

Existing branch (if any):

Name of branch

Address

Niche of course offered

82

PART V

PROPOSED COURSE OF STUDY AND TRAINING PROGRAMME

Name of course of study/

training programme

Field Level

Type of course of study

Mode of delivery

Course duration

Entry qualifications

Collaborative partner

(if applicable)

Awarding body or institution

Yearly

Overall course

P.U. (A) 53 83

PART VI

PROJECTED NUMBER OF STUDENTS AND TEACHERS

Name of course of study/

Training programme

Field

Projected number of students and teachers

(for five year planning after registration)

Year 1

Year 2

Year 3

Year 4

Year 5

STSTSTSTST

Total

(Note: S: Student, T: Teacher)

PART VII

FINANCIAL SOURCES

Source

Amount (RM)

Total

P.U. (A) 53 84

PART VIII

PREMISES AND FACILITIES

1.

Type of premises:

(Note: Please tick (√) whichever is applicable)

Shop lot

Purpose-built campus

Shopping complex

Residence

Office lot

Others (please specify):

________________________________________________________________________________

2.

Ownership of premises:

(Note: Please tick (√) whichever is applicable)

Self-owned premises

Purchase price of premises (if applicable):

__________________________________________________________________________________________

Rented premises

Rental amount: RM ______________________________________________ per *month/year

Date of expiry of rental period: _________________________________________________

Name of owner of premises: _________________________________________________

P.U. (A) 53 85

Address:

_________________________________________________

_________________________________________________

Postcode:

_________________________________________________

District:

_________________________________________________

State:

_________________________________________________

3.

Floor area of premises: ________________________________ *square metre/square feet

Site area of premises: ________________________________________________ *hectare/acre

(Note: *Delete whichever is not applicable)

4.

Particulars of building:

Name of building

Type of use

Total number of rooms

5.

Particulars of recreational facilities:

Type of recreational facilities

Total number of recreational facilities

P.U. (A) 53 86

6.

Particulars of other facilities:

Type of facilities

Total number of facilities

PART IX

PROPOSED HEAD OF BRANCH

1.

Full name: ____________________________________________________________________________

(Capital Letters)

2.

*I.C. No./Passport No.: ____________________________________________________________

(Note: *Delete whichever is not applicable)

3.

Citizenship: ____________________________________________________________

4.

Information on current employment (if any):

Designation:

____________________________________________________________

Name of employer: ____________________________________________________________

Passport size photograph

P.U. (A) 53 87

Address of employer: ______________________________________________________________

______________________________________________________________

Postcode: ______________________________________________________________

District: ______________________________________________________________

State:

______________________________________________________________

Telephone No.: ______________________________________________________________

Fax No.: ______________________________________________________________

E-mail:

______________________________________________________________

5.

Highest academic qualification or professional qualification:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

6.

Employment experience:

Name and address of organization

Year

Designation

From

To

P.U. (A) 53 88

PART X

DECLARATION

I, ____________________________________________________________________________________________________

*I.C. No./Passport No. ____________________________________________________________________________

Chief Executive of _________________________________________________________________________________

(name of private higher educational institution) do solemnly declare that—

(b)

to the best of my knowledge, all members of the management of the company including any director, manager, secretary or any person holding other similar designation in the company, as well as all staff and teachers of the private higher educational institution have no criminal conviction; and

(c)

to the best of my knowledge, all members of the management of the company are not declared as bankrupts.

Signed and declared by,

Official Stamp

___________________________________

________________________

(Signature)

(Date)

Full Name: ___________________________________________________________________________

*I.C. No./Passport No.: ___________________________________________________________________________

(Note: *Delete whichever is not applicable)

P.U. (A) 53 89

SECOND SCHEDULE

[Subregulations 2(2) and 5(2)]

FEES

Matter

1.

Application for approval to establish:

(a)

University 2000.00

(b)

University College 2000.00

(c)

Foreign branch campus 2000.00

(d)

College 500.00

2.

Application for approval to establish a branch of:

(a)

University 2000.00

(b)

University College 2000.00

(c)

College 500.00

Made 19 February 2018

[KPT.U.

DATO' SERI IDRIS BIN JUSOH

Minister of Higher Education