Doc No.

HQ-F002
Access Card & Sticker Form Page No. Page 1 of 2
Revision 00
SC & SF Checked: **Attached SOA with zero or negative balance

REFERENCE NO : TPM/ISO/ABBREVIATION /CARD-STICKER/ YYYYMMDD-NO

Type of Application: Type of Access *(Other than car sticker applications) :
New access card New car Sticker Master card (MC) RFID
Replacement card Replacement sticker Lift access card (LA) Number Plate
Additional card Additional sticker Vehicle entry card (VE) Recognition (NPR)

APPLICANT’S INFORMATION
Name
IC Number
Unit No Contact No
Email address
Status of Applicant Owner/Tenant

VEHICLE PARTICULARS (FOR MASTER/ENTRY/RFID/NPR & CAR STICKER ONLY)

SERIAL NO / DATE
NO VEHICLE NO MODEL COLOUR BAY NO
CODE ISSUED
1
2
3

NEW CARD PARTICULARS

NO SERIAL NO DATE OF ISSUE REMARKS
1
2
3

DEACTIVATION OF CARD/RFID/NPR
NO SERIAL NO DATE OF DEACTIVATION REMARKS (e.g Lost)
1
2
3

TERMS & CONDITIONS

1. Each unit shall have a maximum of ___ Access Card(s) and any additional card applied is subject to a surcharge of
RM__________ per additional card.
2. Any replacement of lost or damaged card(s) is/are subject to a surcharge of RM ____ per card
3. Tenants are required to attach an authorisation letter from the Owner as evidence to support the application failing which,
only the Owner can make the application.
4. All residents (Owners and Tenants) shall abide and observe the House Rules issued by the Management from time to time.
5. A penalty of RM _________ shall be imposed by Management to any clone card user.

I hereby confirm that I have read and agree to the abovementioned terms and conditions

……………………………….
Name :
Date :
FOR OFFICE USE
Issued by, Rejected/Approved by,

Name : Name :
Date : Date :