STUDENT AFFAIRS DIVISION (BHEP) Your Photo Here

ACCOMMODATION APPLICATION FORM

(FOR INTERNATIONAL HOUSE/JAPAN APARTMENT/SPECIAL)

PARTICULARS OF APPLICATION DATE OF APPLICATION : D D M M Y Y

Tick ( / ) at relevant boxes.

Postgraduate Undergraduate (International) RESIDENTIAL COLLEGE :

Exchange Others (please state) :

FULL NAME :

I/C / PASSPORT NO. : MATRIC NO. : RELIGION :

CONTACTE NO. : EMAIL ADDRESS :

GENDER : FACULTY : NATIONALITY :

MARITAL STATUS : SINGLE MARRIED

PARTICULARS OF PERIOD

STARTING DATE : END DATE : NO. OF DAYS :

PURPOSE OF APPLICATION :

APPLICANT'S SIGNATURE

1
DOCUMENTS

Please attach the following documents : Check List :

1) One copy of offer letter (new students)/ Matric Card (current students)

2) One copy of passport (main page only - international students)/ IC (local students)

3) One photo (passport size)

PAYMENT METHOD

Select the preferred method of payment :

Direct payment through UM E-Payment (provide proof of payment after application has been approved by BHEP)

Charged to Student Account (only for student)

APPLICANT'S SIGNATURE

FOR BHEP OFFICE USE

Approved

Not Approved

Date : D D M M Y Y

STUDENT AFFAIRS OFFICER SIGNATURE

FOR E-COLLEGE ISIS ADMIN USE Accommodation Type :

Unit No. :