ORBIT : Online Registration & Billing Information Tracker

1.0 Enrollment Information

Province: *

City: *

Branch: *

Year Intake: *

Enrollment Start: *

Previous School:

2.0 Student Details

Name: *

Birth Certificate Number: (Prepare a Copy for Management Purpose)*

Religion: *

Race: *

Gender: *

Birth Date: (Required For Management Purpose)*

Birth Place: *

Family Card Number: (Prepare a Copy for Management Purpose)*

Favorite Food or Drink:

Illness/Alergic: *

Other Information:

Immunization: (Prepare a Copy for Management Purpose)*

3.0 Guardian/Father/Mother Information

Name: *

Identity Number (NIK/KTP): *

Email Address: *

Relation With Student:

Mobile Phone: *without (-)

Home Phone:

Home Address:

Occupation:

Employer:

Salary:

Office Address:

Office Phone:

4.0 Spouse Information

Name: *

Identity Number (NIK/KTP): *

Email Address:

Relation With Student:

Mobile Phone: *without (-)

Home Phone:

Home Address:

Occupation:

Employer:

Salary:

Office Address:

Office Phone:

5.0 Emergency Contact

Name: *

Identity Number (NIK/KTP):

Email Address:

Relation With Student:

Mobile Phone: *without (-)

Home Phone:

Office Phone:

I hereby certify that the above information given are true and correct as to the best of my knowledge.
lllllllI am also understand and agree that my personal data will be stored, processed, and used under Little Caliphs International Sdn Bhd Data Protection Policy.

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