No.

Rujukan:

Reference No:

JABATAN CANSELORI/CHANCELLERY
UNIVERSITI UTARA MALAYSIA
TEL.: 04-928 3039/3040 FAKS: 04-928 3053
E-MEL:ukkuum@uum.edu.my
FACEBOOK: Universiti Utara Malaysia (Official FB)

BORANG PERMOHONAN PERKHIDMATAN

SERVICES APPLICATION FORM

BORANG PERMOHONAN INI PERLU DIHANTAR SATU (1) MINGGU SEBELUM TARIKH
PROGRAM BERLANGSUNG / FORM HAS TO BE SENT 7 DAYS PRIOR TO EVENT DAY

MAKLUMAT PEMOHON
APPLICANT’S INFORMATION

1. Nama/Name

2. Jawatan/Position

3. Pusat Tanggungjawab/
Department 5. Telefon/Telephone: 6. Faks/Fax:
E-Mel/E-mail:

4. Tandatangan Pemohon
& Cap Jawatan/
Signature & Official
Stamp Tarikh/ Date:

MAKLUMAT PROGRAM /MAJLIS / PROGRAMME / EVENT INFORMATION

Nama Program/Majlis
Name of Programme/Event

Butiran Majlis/ Tarikh/Date: Masa/Time:

Particulars of Event
Hari/Day: Tempat/Venue:

Anjuran/Organiser

Bahan Yang Disertakan/ Salinan Elektronik/ Salinan Bercetak/

Accompanied Material(s) Electronic Copy Printed Copy

1
 SILA TANDAKAN ( / ) PADA PETAK BERKENAAN
PLEASE PUT A CHECK ( / ) IN THE RELATED BOX

i. Jemputan Perasmi Program/ ii. Jemputan tetamu kenamaan

Majlis dari luar/
Invitation of Person(s) Officiating Invitation of External VIPs
Programme/Event
iii. Jemputan Ahli Jawatankuasa iv. Raptai/
Pengurusan Universiti/ Rehearsal
Invitation of the members of the
University Management Committee
v. Penasihat Protokol Majlis/ vi. Semakan Teks Pengacaraan/
Advisory of Event Protocol Review of the Emcee Text
vii. VVIP tagging viii. Semakan Atur Cara Majlis/
Review of the Order of Event

LIPUTAN MEDIA/ MEDIA COVERAGE

i. Liputan Berita/ ii. *Sidang Media/
News Coverage Media Conference
iii. Undangan Media Luar/ iv. Siaran Media/
External Media Invitation Press Release

PUBLISITI/ PUBLICITY
Stesen Televisyen/
Television Station
 Lain-Lain/Others
 Slot Wawancara/
Interview Slot
Sila nyatakan: ____________________
 Crawler/ (please state the details)
Crawler

FOTOGRAFI/PHOTOGRAPHY
i. Liputan Keseluruhan/ iv. Gambar Segera/
Overall Coverage Instant Photo
ii. Foto beramai-ramai/ v. Studio Foto/
Group Photo Photo Studio
iii. Salinan gambar/
Copy of Photo(s)
Nota : UKK tidak akan menanggung kos yang terlibat atas khidmat yang dipohon
oleh penganjur
Note: UKK will not bear the costs involved for the service(s) requested by the
organiser(s)

CORPORATE IMAGE GRAPHICS

i. Reka Bentuk/ CI Poster Interior
Design
Logo Layout Gimmicks

Cover Advertisment Exhibition

Streamers Brochure Decoration

Bulletin Billboard Signage

Banner Backdrop

ii. Cetakan/ Tarpauline/ Kad/ Lain-lain/

Printing Tarpaulin Card Miscellaneous

Kertas/ Ink Jet

Paper
iii. Saiz/
Size

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 BAHAGIAN B / PART B
DIISI OLEH PUSAT TANGGUNGJAWAB / TO BE FILLED BY THE CENTRE/DEPARTMENT

PERAKUAN KETUA PUSAT TANGGUNGJAWAB/ DECLARATION BY HEAD OF DEPARTMENT

Tandatangan Ketua PTJ & Cap Jawatan/

Signature of the Head of Department & official
stamp

Tarikh/ Date:

BAHAGIAN
KELULUSAN PENGARAH UNIT KOMUNIKASI KORPORAT
/ APPROVAL OF THE DIRECTOR OF CORPORATE COMMUNICATION UNIT

Kelulusan/ Approval Lulus/Approved Tidak Lulus/

Not Approved

Tandatangan & Cap Jawatan/

Signature & official stamp

Tarikh/ Date:

Tindakan / Action Seksyen / Section Catatan / Remarks

Unit Pengurusan Acara
Event Management
Unit Penerbitan Korporat
Corporate Publication

Unit Fotografi
Photography

Unit Bilik Berita Digital

Digital newsroom

Unit Imej & Grafik Korporat

Corporate Image & Graphic

Anjung Tamu
Welcome Centre

Kemaskini : 15 Ogos 2022

HRHR/ndo

3
 Lampiran 1
Appendix 1

SIARAN MEDIA/
PRESS RELEASE

1. NAMA PROGRAM/ :
NAME OF PROGRAMME

2. TARIKH/ :
DATE

3. MASA/ :
TIME

4. TEMPAT/ :
VENUE

5. PENGANJUR/ :
ORGANISER(S)

6. TETAMU KEHORMAT/ :
DISTINGUISHED GUEST(S)

7. OBJEKTIF/ :
OBJECTIVE(S)

8. PERKARA YANG :
MENARIK/ATTRACTION

KEKUATAN/STRENGTH :

KELAINAN/SIGNIFICANT :

KELEBIHAN/ADVANTAGE :

BERIMPAK TINGGI/HIGH IMPACT :

KEISTIMEWAAN/SPECIALITY :

9. PERINGKAT
 DOMESTIK/DOMESTIC :

 ANTARABANGSA/ :
INTERNATIONAL

Kemaskini: 15 Ogos 2022

HRHR/ndo