You are on page 1of 1
VEHICLE STICKER APPLICATION APPLICANT INFORMATION Name: NRIC : Student ID : Contact No (HP) :
VEHICLE STICKER APPLICATION
APPLICANT INFORMATION
Name:
NRIC :
Student ID :
Contact No (HP) :
Courses :
Intake :
Current Semester :
Current address:
City:
State:
ZIP Code:
VEHICLE INFORMATION
Types of vehicle (Car) :
Plate No :
Model :
Color :
Registration Date (Start):
Registration Date (End):
Types of vehicle (Motorcycle) :
Plate No :
Model :
Color :
Registration Date (Start):
Registration Date (End):
ACKNOWLEDGEMENT
1.
I agree to comply with the Road Transport Department Act 1987 and all regulations implemented
by Multimedia College (Northern) from time to time.
2.
I understand if I fail to comply with any rules outlined by the management of MMC(n), I can be
convicted under the traffic regulations of MMC(n).
3.
I also understand that MMC(n) will not be liable for any damage or loss caused to vehicles parked at the
College.
4.
I also declare that all information given is true.
I hereby understand and agreed to abide all the regulations outlined by MMC(n).
APPLICANT SIGNATURE :
DATE :
…………………………………………………
………………………………
FOR OFFICE USE
Application Status :
Approved
Not Approved
Process
( Please Mark / )
PLEASE STATE REASONS :
Amount :
Session :
Sticker
Payment :
Details :
Date
:
Plate No:
DOCUMENTS CHECKLIST :
(/)
Copy of IC
Copy of Student ID
ADMIN
Signature :
Copy of License
Copy of Road Tax
Date
:
Copy of Insurance Policies