Student Accommodation Application Form Please affix your

Heriot-Watt University Malaysia colour photograph

here
PLEASE USE CAPITAL LETTERS ONLY
Please provide:
2 copies of colour photograph and a copy of NRIC/ Passport
SECTION A - PERSONAL DETAILS
Name of Applicant :
NRIC / Passport No : Date of Birth :
Nationality : Religion :
Gender : Male ( ) Female ( )
Permanent Address :

Postcode : Country :
Residence Tel No : Mobile No :
Email Address :
Programme :
Intake : Jan ( ) April ( ) July ( ) Sept ( )
Others : Year :
Name of Room Mate (if any) :
SECTION B - EMERGENCY CONTACT (PARENT / GUARDIAN)
Name :
Email Address :
Relationship : Contact No :
SECTION C - ACCOMMODATION & ROOM OF YOUR CHOICE

REFUNDABLE AT END OF TENURE

Pls no 1&2 to RENTAL UTILITIES SECURITY ACCESS CARD TOTAL PAYABLE ADMIN CHARGES
indicate your UNIT & ROOM TYPE IN ADVANCE DEPOSIT DEPOSIT DEPOSIT (1st Payment) (2nd Payment)
preference 1 month, MYR 1 month, MYR 1 month, MYR MYR MYR MYR
SHAFTSBURY SERVICED RESIDENCES ( Air - Conditioned )
Type C : Studio unit
( ) Single (En suite) 2600 2600 2600 50 7850 265
( ) Twin Sharing (En suite) 1300 1300 1300 50 3950 265
Type A2 : 3 Bedrooms & 2 Bathrooms unit
( ) Single 1380 1380 1380 50 4190 265
( ) Twin - Sharing 1250 1250 1250 50 3800 265

Block C at THE ARC ( Air - Conditioned )

BLOCK C : 3 Bedrooms & 2 Bathrooms unit
( ) Single (Ensuite) 1200 1200 1200 50 + 20 3670 265
( ) Single (Intermediate Room 2) 1000 1000 1000 50 + 20 3070 265
( ) Single (Small Room) 800 800 800 50 + 20 2470 265
( ) Twin Sharing (Ensuite) 600 600 600 50 + 20 1870 265
( ) Twin Sharing (Intermediate Room 2) 500 500 500 50 + 20 1570 265
( ) Twin - Sharing (Small Room) 400 400 400 50 + 20 1270 265
Note : Admin Charges and Starter Kit inclusive of 6% Goods and Services Tax (GST)

Remarks :