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PK.FKK.PPLI.

TAWARAN (1)

INDUSTRIAL TRAINING PLACEMENT FORM


Reference No. : ..........................................................
Date : ..........................................................

Asdarina Yahya
Industrial Training Coordinator
Faculty of Chemical Engineering
Universiti Teknologi MARA
40450 Shah Alam
Selangor Darul Ehsan
Phone: 03-55438417
Email: fkkuitm.eh221@gmail.com

Fax: 03-5543 6300


We hereby AGREE / DISAGREE* to accept your student to undergo the industrial training in our
th nd
company within the period of 17 July until 22 September 2017. The particulars of the arrangement
are as follows:

Students name : ....................................................................................


Company name : ....................................................................................
Company address : ....................................................................................
....................................................................................
....................................................................................
Supervisors name : ....................................................................................
Department : ....................................................................................
Monthly allowance (if any) : ....................................................................................
**
Offer valid until : ....................................................................................

Please indicate the job roles/responsibilities of this trainee in your organization (compulsory to fill):

Thank you.

Yours faithfully

(Signature)
Name: ................................................................................
Position: ............................................................................
Contact no.: ......................................................................
* Please cross the inapplicable
** Final date in which the student must send official notification to the company / organization
confirming placement. In the event that no notification is sent, the above offer automatically
becomes null and void.

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