PHYSICS DEPARTMENT

College of Science

Request to Borrow

Date: __________________________
Borrower’s Name: _________________________________________________
ID No.: _______________________
Adviser’s Name: ______________________________________

List of Equipment:
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______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Dates of Usage: ______________________________

Where will the equipment be stationed?

______________________________________________________________________________

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Borrower’s Commitment:
I will be accountable to any damage incurred in the equipment and will return the equipment
promptly and in the same working condition it was borrowed.

_____________________________________
Signature of Borrower
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Approved by:

________________________________
Physics Laboratory Coordinator

Remarks: _____________________________________________________________________
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