HOSTEL APPLICATION FORM

A. PERSONAL INFORMATION
Family Name / Surname (as printed in IC / Passport):

___________________________________________________

Given Name (as printed in IC / Passport):

___________________________________________________

Gender: Male/ Female

Marital Status: Single/ Married/ Divorced/ Widowed

Date of Birth: Age:

Place / Country of Birth:

Religion: Islam/ Buddhist/ Hindu/ ChrisIan/ Others (please specify)

___________________

NRIC:

Passport Number:

A. PERSON TO CONTACT IN CASE OF EMERGENCY

Name:

Contact Number:

Address:

RelaIonship:
 C. DECLARATION

• The COMPANY and its management will not be held responsible for any damages,
losses or injuries arising from residing in the company provided hostel.
• All staffs must abide by Hostel Rules and RegulaIons. Failure to do so may result in
expulsion, suspension, private or public sancIons.

I hereby declare that all informaIon furnished above are accurate and true to the best of my
belief and knowledge and that the company may terminate or withdraw this applicaIon
should any informaIon is discovered to be inaccurate or untrue. I have read the Terms and
CondiIons and agree to abide by all the sIpulated rules and regulaIons.

Signature

Date:

No. Keys and Access card Obtained :

Key :

Card :