SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM APPLICATION FOR ATTENDING
Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.
Tel: 09-591 2500
SASMEC-HR-F001 VER: 01 REV: 07 EFFECTIVE DATE: 09 MAY 2023
CONFERENCE / SEMINAR / WORKSHOP / MEETING / COURSE / TRAINING
A. PERSONAL DETAILS NAME
STAFF NO. POSITION
DEPARTMENT H/P NO. / EXT NO.
B. APPLICATION DETAILS
CONFERENCE SEMINAR COURSE/TRAINING COMMITTEE MEETING WORKSHOP
OTHERS, PLEASE SPECIFY: _______________________________________________________________________________________________________
TITLE
DATE DURATION VENUE
ORGANIZED BY
FINANCIAL : SPONSORED BY ORGANIZER SELF-SPONSORED REQUIRES UNIVERSITY SPONSORSHIP
NEED ACCOMMODATION? YES NO
NEED TRANSPORT? YES NO
If sponsorship required, kindly fill in the following:
PO ( ) FEES : _________________________ ACCOMMODATION : ____________________________
REIMBURSE ( ) TRAVELLING : _________________________ FOOD : ____________________________
TOTAL : _________________________
APPLICANT’S SIGNATURE : __________________________ DATE : ____________________
C. RECOMMENDATION BY HEAD OF DEPARTMENT (D/U/C/W)
THE ABOVE APPLICATION IS: RECOMMENDED NOT RECOMMENDED
COMMENT (IF ANY): _______________________________________________________________________________________________________________
SIGNATURE : __________________________ DATE : ____________________
NAME :
__________________________
(Official Stamp)
FOR OFFICE USE ONLY NOTE (HRD UNIT) :
D. RECOMMENDATION BY THE HEAD OF THE DEPARTMENT OF
HUMAN RESOURCE E. RECOMMENDATION BY HEAD OF DEPARTMENT FINANCE
THE ABOVE APPLICATION IS: THE ABOVE APPLICATION IS:
RECOMMENDED NOT RECOMMENDED RECOMMENDED NOT RECOMMENDED
COMMENT (IF ANY): ____________________________________________ COMMENT (IF ANY): _______________________________________________
SIGNATURE : ________________________ SIGNATURE : _________________________
NAME :
________________________
(Official Stamp)
NAME :
_________________________
(Official Stamp)
DATE : ________________________ DATE : _________________________
F. APPROVAL BY HOSPITAL DIRECTOR / DIRECTOR (CLINICAL) / CAMPUS DIRECTOR
THE ABOVE APPLICATION IS: APPROVED WITH BUDGET APPROVED WITHOUT BUDGET
COMMENT (IF ANY): _______________________________________________________________________________________________________________
SIGNATURE : ________________________ DATE : ___________________
NAME :
________________________
(Official Stamp)
