Revision No.: 03 Date of revision: 1 December 2005 Ref No.

: IIUM/206/12/3/4 STUDENT AFFAIRS DIVISION INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA APPLICATION TO REGISTER ELECTRICAL APPLIANCES Name Matric No. Mahallah : : : _________________________________________________________ __________________ __________________ __________________ Room No. : _______________ _______________ _______________

Year of Study : Kull/Prog :

Telephone No.:

All students who are using the following appliances are required to register the item(s) at the Mahallah Office. (Please tick ( ) where applicable) FOR OFFICE USE MODEL / PLEASE SERIAL SERIAL EXPIRY TICK NO. ITEMS CHARGES NO. NO. DATE (STICKER) ( ) (ITEM) 1 2 3 4 5 6 7 Kettle (automatic) Iron Radio / Transistor Computer set Hair dryer Automatic bread toaster (Sandwich toaster is not allowed). Stand Fan (for Usrah Room/Transit Room Only) RM5.00 RM5.00 RM5.00 RM10.00 RM5.00 RM5.00 Free of charge

_________________________________________ Applicants Signature

____________ Date

Important notes: a. All authorized items must be registered. b. Unregistered items will be confiscated and a maximum penalty of RM 50.00 will be imposed on each item.

FOR OFFICE USE ONLY

Certified by: