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Students Membership Form/ Uva Wellassa University Library

USER DETAILS

Student Registration Number

NIC No.
Name of Faculty: …………………………………….Name of the Department:………………………

Full Name with Initials (Capital Letters)

Rev./Mr./Mrs/
Ms..............................................................................................................................................................
.............................................................................................................................................

Gender Female/Male Date of Birth Year Month Date

Name of the Parents/ Guarantor: …………………………………………………………………........

Residential Address
(Home): .....................................................................................................................................................
....................................................................................................................................................................
...............
Phone Number (Home) Phone Number (Mobile)
Email Address

IMPORTANT FOR YOU

1. Kindly notify on any problems related to your library account to the library within 7 days.
2. Please follow the Library Rules and Regulations provided by the Uva Wellassa University
Library.
3. Charges on lost or damaged library books will be charged according to the policies related to
the same.
DECLARATION OF THE USER

I hereby agree with the terms and conditions of the Uva Wellassa University Library. I also give my
consent to charge any unsettled dues at the time of my release from the University.

Name: .................................................................. Signature: .........................................................

(Please provide your E-Signature.)
OFFICIAL USE ONLY

Library Membership Number: …………… Name of the Circulation Officer………………...

Name of the officer (Data entering to the system): …………………………………………………