FD Application Form

This is the Family Discount Application Form

Please complete the form in full, failure to do so may delay in the processing of your application.

Your application will only be considered if you answer all relevant sections fully.

If you have difficulties completing this form, please contact: numed-finance@newcastle.edu.my

Application Details
Applicant Name * First Last
Please complete your name as it appears on your University record
Applicant Date of Birth * / MM / DD YYYY
Correspondence Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
This should be your current place of residence
Telephone Number *

If providing an international number, please include the international dialing code (e.g. the code for India is +91)
Email Address *

If you have a Newcastle University email account, please use this email address.
Nationality *
Applicant Course Details
Applicant/Student Number *
Degree Programme/Programme of Study *
Have you applied for, or been awarded funding from any other sources? *
Yes No
If yes, please provide us with the details*
Details of your relative

Please complete whether your relative has graduated or currently studying at Newcastle University Medicine Malaysia

The following section solely relates to your relative.
Name of Relative * First Last
Date of Birth * / MM / DD YYYY
Relationship to you (the applicant) *

This must be a close family member e.g. husbands & wives, brothers & sisters, fathers & mothers, sons & daughters.
Student number (if known)
Degree Programme/Programme of Study *
Date of Graduation (if they have graduated) / MM / DD YYYY
Applicant declaration
I confirm that I have read and understood the regulations and confirm that the information I have given is correct to the best of my knowledge *
Yes
Date * / MM / DD YYYY

Please enter today's date
Evidence of Relationship *

Attach Files Attach Files

Once this form is complete, please use this section to upload the required evidence for your application.

Use numerous 'Browse...' links to upload multiple documents if required.

E.g. relevant Degree Certificates, Marriage / Birth Certificates etc
For siblings, Birth Certificate are preferred.
Further Evidence of relationship

Attach Files Attach Files
Further Evidence of relationship

Attach Files Attach Files
Further Evidence of relationship

Attach Files Attach Files
Further Evidence of relationship

Attach Files Attach Files
Data Protection Statement

The University will retain information supplied on this form for a maximum of three years. This information will be accessible to staff in Finance Section only

FD Application Form

FD Application Form

Application Details

Applicant Course Details

Details of your relative

Applicant declaration

Data Protection Statement