UTHM.

BENDAHARI 1

DUTY
STAMP
RM 10.00

FINANCIAL GUARANTEE FORM FOR THE FIRST GUARANTOR

GUARANTOR’S DECLARATION

1. In consideration of the offer made by Universiti Tun Hussein Onn Malaysia to a student mentioned
herein, I hereby agree to become a guarantor to the student by the name of
.........................................................................................................................................................
.................... Matric No. .......................................... Identity Card/MyKad No.
................................................ while he/she is studies at Universiti Tun Hussein Onn Malaysia
(UTHM).

If he/she leaves the University or defaults on his/her payment of any debts to UTHM, I will
guarantee, jointly and severally with the other guarantors, to pay all debts owed to UTHM by this
student and all legal costs related to such claims (if any).

With this, I jointly and severally with any other guarantors, guarantee that during the course of
his/her study, the above-named student will comply with the Universities and University Colleges
Act, 1971 and all applicable regulations to UTHM. If he/she commits a violation or is convicted of
an offence, I will willingly pay the damages or fines demanded by UTHM.

2. The following are my personal details:

a. Name : ………………………………………………………….
b. Identity Card/MyKad No. : ………………………………………………………….
c. Relationship with student : ………………………………………………………….
d. Telephone No : ………………………………………………………….
e. Relationship with student : ………………………………………………………….
………………………………………………………….
………………………………………………………….
f. Occupation/Designation : ………………………………………………………….
g. Office Address : …………………………………………………………
………………………………………………………….
………………………………………………………….
h. Name & Address of Employer : ………………………………………………………….
i. Office Telephone No : ………………………………………………………….
j. Total Income : ………………………………………………………….
k. Net Salary : ………………………………………………………….
l. Properties Owned : ………………………………………………………….
 a) Land (land area & value) : ………………………………………………………….
b) Residential unit (value) : ………………………………………………………….
c) Other properties
(such as shops, etc) : ………………………………………………………….
d) No. of dependants : ………………………………………………………….

I declare that all the statements and declarations made above are true, and that I am liable for them.

………………………………………………………
Signature of First Guarantor
Date : …………………………………

WITNESS

………………………………………………………
Signature and Official Stamp of Witness

Date : ………………………………………………………….
Name : ………………………………………………………….
Identity Card / MyKad No. : ………………………………………………………….
Designation : ………………………………………………………….
Office Address : ………………………………………………………….
………………………………………………………….
………………………………………………………….
Office Telephone No : ………………………………………………………….

Note : i. The First and Second Guarantors must be two different persons whose monthly incomes are at least RM500.00
each.

ii. The First and Second Guarantors can also be the student’s father/mother/guardian.

iii. The completed Financial Guarantee Form must be stamped at any Inland Revenue Board of Malaysia Ofiice
(LHDN) or Commissioner of Oaths with a RM10.00 revenue stamp on each copy.

iv. The witness must either be a Councillor, Justice of Peace, Government Officer at the Management or
Professional level, Principal/Headmaster, Headman or Community Leader.
 UTHM.BENDAHARI 1

DUTY
STAMP
RM 10.00

FINANCIAL GUARANTEE FORM FOR THE SECOND GUARANTOR

GUARANTOR’S DECLARATION

3. In consideration of the offer made by Universiti Tun Hussein Onn Malaysia to a student mentioned
herein, I hereby agree to become a guarantor to the student by the name of
.........................................................................................................................................................
.................... Matric No. .......................................... Identity Card/MyKad No.
................................................ while he/she is studies at Universiti Tun Hussein Onn Malaysia
(UTHM).

If he/she leaves the University or defaults on his/her payment of any debts to UTHM, I will
guarantee, jointly and severally with the other guarantors, to pay all debts owed to UTHM by this
student and all legal costs related to such claims (if any).

With this, I jointly and severally with any other guarantors, guarantee that during the course of
his/her study, the above-named student will comply with the Universities and University Colleges
Act, 1971 and all applicable regulations to UTHM. If he/she commits a violation or is convicted of
an offence, I will willingly pay the damages or fines demanded by UTHM.

4. The following are my personal details:

m. Name : ………………………………………………………….
n. Identity Card/MyKad No. : ………………………………………………………….
o. Relationship with student : ………………………………………………………….
p. Telephone No : ………………………………………………………….
q. Relationship with student : ………………………………………………………….
………………………………………………………….
………………………………………………………….
r. Occupation/Designation : ………………………………………………………….
s. Office Address : …………………………………………………………
………………………………………………………….
………………………………………………………….
t. Name & Address of Employer : ………………………………………………………….
u. Office Telephone No : ………………………………………………………….
v. Total Income : ………………………………………………………….
w. Net Salary : ………………………………………………………….
x. Properties Owned : ………………………………………………………….
 a) Land (land area & value) : ………………………………………………………….
b) Residential unit (value) : ………………………………………………………….
c) Other properties
(such as shops, etc) : ………………………………………………………….
d) No. of dependants : ………………………………………………………….

I declare that all the statements and declarations made above are true, and that I am liable for them.

………………………………………………………
Signature of Second Guarantor
Date : …………………………………

WITNESS

………………………………………………………
Signature and Official Stamp of Witness

Date : ………………………………………………………….
Name : ………………………………………………………….
Identity Card / MyKad No. : ………………………………………………………….
Designation : ………………………………………………………….
Office Address : ………………………………………………………….
………………………………………………………….
………………………………………………………….
Office Telephone No : ………………………………………………………….

Note : i. The First and Second Guarantors must be two different persons whose monthly incomes are at least RM500.00
each.

v. The First and Second Guarantors can also be the student’s father/mother/guardian.

vi. The completed Financial Guarantee Form must be stamped at any Inland Revenue Board of Malaysia Ofiice
(LHDN) or Commissioner of Oaths with a RM10.00 revenue stamp on each copy.

vii. The witness must either be a Councillor, Justice of Peace, Government Officer at the Management or
Professional level, Principal/Headmaster, Headman or Community Leader.