APPLICATION FOR RESIDENTIAL COLLEGE THE NATIONAL UNIVERSITY OF MALAYSIA

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APPLICATION FOR RESIDENTIAL COLLEGE THE NATIONAL UNIVERSITY OF MALAYSIA

UNIVERSITI KEBANGSAAN MALAYSIA (UKM)

(STUDENT EXCHANGE PROGRAMME)

Note: Please note that the reservation of accommodation in the UKM residential colleges are subject to availability and approval by the Management of Residential College.

Student No. : Host Faculty :

1. Full name :

(Block Letters in accordance to passport)

2. Gender : 3. Age :

4. Passport No. : 5. Expiry Date : ^{d d} - ^{m m} - ^{y y y y}

6. Date of Birth : ^{d d} - ^{m m} - ^{y y y y}

7. Nationality : 8. Contact No. :

9. E-mail Address :

10. Home University Name : 11. Current Address :

PROPOSED ACCOMMODATION

12. Please select the room type with mark (√) in the box below:

Single room with shared bathroom

(MYR 680.00 monthly / per person) Sharing room with shared bathroom (MYR 490.00 monthly / per person)

* Student are required to make a deposit of one month rental fee plus first month of fee (1+1) during the day of check-in.

13. Duration of stay :

Check-in Date : ^{d d} - ^{m m} - ^{y y y y} Check-out Date : ^{d d} - ^{m m} - ^{y y y y}

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DECLARATION BY APPLICANT

I hereby declare that all information provided are true and complete. I acknowledge that The National University of Malaysia (UKM) could reject my application or revoke any reservation done if the information provided are found to be untruthful or deceitful. I agreed to abide by the rules and regulations of the Management of Residential College, UKM.

Date : ^{d d} - ^{m m} - ^{y y y y} Signature :

Please email your completed application form to the International Relations Centre (UKM Global) at exchange@ukm.edu.my.

FOR OFFICE USE ONLY

Type of room : College Name :

Room charges : MYR per day per person

Date : ^{d d} - ^{m m} - ^{y y y y} Signature & Official Stamp :