Insan System Sdn Bhd

Friday, 24 May 2013
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Kuin WiFi Services  
KOLEJ UNIVERSITI INSANIAH
LEBUHRAYA SULTANAH BAHIYAH
05350 ALOR SETAR
KEDAH DARUL AMAN

 

APPLICATION FORM FOR INSANIAH WIFI SERVICES

 

NAME
:
IC / PASSPORT NUMBER
:
ADDRESS
:
PHONE NUMBER
:
EMAIL ADDRESS
:
STUDENT MATRIX
:
 used as login
PASSWORD
:
COURSE
:
SEMESTER / SESSION
:
 
Please scan and upload your Registration Payment Slip and your Matrix Card ID.
FILE
:
 
LAPTOP / MOBILE DETAILS
     
TYPE OF ITEMS
:



MAC ADDRESS
:
 HELP
BRAND / MODEL
:
DATE OF APPLICATION
:
(* required field)