Date
: 27 July 2022   
Current User
:
MUHAMMAD AMIR SYAZWAN BIN MOHD ASRI [Log
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PERSONAL INFORMATION FORM FOR HOSTEL APPLICATION

         
FOR OFFICE USE ONLY
      Affix recent
Signature : ___________ passport size
  Recipient Stamp : ___________ STUDENT AFFAIRS OFFICE photo  

UNIVERSITI TEKNOLOGI MALAYSIA

Date : ___________
Block/Room : ___________    
 
  SESSION: 2022/2023  
  COLLEGE: KOLEJ 09 & 10  
         
Full name :  
MUHAMMAD AMIR SYAZWAN BIN        
MOHD ASRI
IC No. :  010111031125   Gender :  L - Lelaki
Matric No. :  A20EE0135   Course :  SEEEH
  Birth Date :  11 January 2001   Place of Birth :  03-KELANTAN  
Religion :  1-ISLAM   Mobile No. :  
0192095748
Citizenship :  M-MALAYSIA   Vehicle No. :   ______________
Email :  
syazwanasri67@gmail.com   Married/Single :  1-BUJANG
             
Health Record (State the type of diseases you have)
a) Asthma : __________________________
b) Allergy : __________________________
c) Others : __________________________
     
Parent/Guardian’s Name : MOHD ASRI BIN DOLAH
Permanent Address : LOT 170 KAMPUNG KANDIS 16800 PASIR  
PUTEH KELANTAN
     
Occupation :  
10
   
Telephone No. (H) :  
097861624
Telephone No. (H/P) :   ______________________________
     
Next of kin to be contacted during emergency
     
Name :  MUHAMMAD AMIR AZFAR BIN MOHD ASRI
Address : LOT 170 KAMPUNG KANDIS 16800 PASIR  
PUTEH KELANTAN
Telephone No. (H) :  --
Telephone No.(H/P) :  ______________________________
     
UTM HOSTEL APPLICATION RESULTS SESSION2022/2023
         
We are pleased to inform you that your hostel application in UTM Skudai
Session 2022/2023 has been approved. The details
   
are as follows:
         
  Name :  MUHAMMAD AMIR SYAZWAN BIN MOHD ASRI  
  IC No./Passport No. :  010111031125  
  Matric No. :  A20EE0135  
  College :  KOLEJ 09 & 10  
  Room Type :  Bilik Berdua /Double Room  
  Date/Time of Application :  27 July 2022, 12:52:39 PM (Wednesday)  
         
  Thank you.  
         
  Warm regards,  
     
  TAHA BIN OTHMAN  
Head Of Deparment
   
Hospitality Cluster
  o/b Deputy Vice Chancellor (Development)  
  Tel: 07-5532549  
         
  * This form has to be submitted
during hostel registration.  
  * Respective college is responsible for giving the room key and room number.  
  * Please fill in your personal information in the PERSONAL INFORMATION FORM FOR HOSTEL APPLICATION.  
  * Please update information if there are any changes.  
  * This is a computer generated letter, no signature is required.  
  * Date of print: 27 July 2022 12:53:20 PM (Wednesday)  

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