1 Unit Perumahan Pelajar, Jabatan Perkhidmatan Pelajar, Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor

Telefon: +603-8921 5307/3092 Faksimili: +603-8925 9884 E-mel: harfiz@ukm.my Laman Web: http://www.ukm.my/upp

Student Housing Unit, Department of Student Services, The National University of Malaysia, 43600 UKM Bangi, Selangor.

Telephone : +603-8921 5307/3092 Facsimile: +603-8925 9884 E-mail: harfiz@ukm.my Website: http://www.ukm.my/upp

UNIT PERUMAHAN PELAJAR (UPP)

(Student Housing Unit)

PERMOHONAN PENGINAPAN (Application For Accommodation)

NO. MATRIK : (Matric #)

FAKULTI / ORGANISASI (Faculty / Organization)

1. Nama (Name)

:

2. No. K/P / No. Pasport (NRIC / Passport #)

:

3. Status (Marital Status)

: 4. Jantina (Gender)

:

5. Alamat E-mel (E-mail Address)

: 6. Tarikh Lahir (Date of Birth)

:

7. No. Telefon (Telephone #)

: 8. Agama (Religion)

:

9. Warganegara (Nationality)

: 10. Penaja (Sponsor)

:

11. Alamat Rumah (Home Address)

:

12. Jenis Bilik Yang Di Pohon (sila tanda (/) dalam ruang yang disediakan) :

(Choice of Room – please mark (/) in the column given)

Bilik Seorang (Single Room)

Pangsapuri UKM Taman Tenaga (UKM Taman Tenaga Apartment)

Bilik Berdua (Twin Sharing)

Pangsapuri UKM Blok 6 (UKM Bandar Baru Bangi Apartment)

Rumah Tetamu UKM (Guest House UKM)

Pangsapuri Kolej Idris Al-Marbawi (Idris Al-Marbawi Residential College)

(Apartment)

13. Tarikh Penginapan : Tarikh masuk Tarikh keluar Duration of stay (Check-in date) (Check-out date) Keperluan penginapan : (Reasons/Purpose for accommodation)

GAMBAR (Photo)

2 Unit Perumahan Pelajar, Jabatan Perkhidmatan Pelajar, Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor

Telefon: +603-8921 5307/3092 Faksimili: +603-8925 9884 E-mel: harfiz@ukm.my Laman Web: http://www.ukm.my/upp

Student Housing Unit, Department of Student Services, The National University of Malaysia, 43600 UKM Bangi, Selangor.

Telephone : +603-8921 5307/3092 Facsimile: +603-8925 9884 E-mail: harfiz@ukm.my Website: http://www.ukm.my/upp

14. Perakuan Pemohon : (Declaration:)

Dengan ini saya mengesahkan segala butiran yang tercatat adalah benar dan berjanji

akan mematuhi segala peraturan Kolej dan Universiti. (I declare that the above information given is correct to be best of my knowledge and I agreed to abide by the rules and regulations of the Housing and the University.)

Tandatangan (Signature)

Tarikh (Date)

Bahagian Pentadbiran Unit Perumahan Pelajar (Student Housing Unit) Nama : (Name) Alamat Rumah : (Home Address)

No. Telefon

:

(Telephone #) Ingin dimaklumkan permohonan anda *Diluluskan/Tidak diluluskan. (This is to inform you that your application *Approved/Not Approved) Jenis Penginapan : Kadar Sewa : seorang sehari Types of Accommodation Room Charges per person per day

Tandatangan (Signature)

Tarikh (Date)

PERHATIAN: Anda diminta memaklumkan kepada pihak pentadbiran UPP sekiranya ada

tambahan/pembaharuan maklumat. Kelulusan tertakluk kepada kekosongan dan peraturan penginapan Unit Perumahan Pelajar.

(IMPORTANT NOTE: You are required to inform the Student Housing Units for any changes of particulars. Approval are subjected to rooms availability and housing regulation Acts)