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Car Version No : 01

RM 3.00 T2 Revision : 02
Per Sticker Effective Date : 01st October 2015
OFFICE OF SECURITY MANAGEMENT
Motorcycle Work Station : OSeM
INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA
PARTICULARS OF APPLICANT
VEHICLE STICKER APPLICATION FORM
Tick ( / ) at relevant boxes

Full Name :

Staff No. Matric No. ( Student ) I/C / Passport No .

Staff

Student On Campus
Dept. / Kull ( Staff / Student ) Mahallah : ( Student ) Room No :

Student Off Campus

IIUM Holdings
Year of Study H/P No . Tel. No . Office :
Contractor
Year
Business
Home Address ( Student Off Campus, Contractor, Business, Consultant, Part time )
Consultant

Part Time
Staff/student

New Application :- Please enclose the photocopy of the following documents :


( Car only ) Matric Card, Valid Driving Licence, Vehicle Registration Card, LOC Letter ( Student Off Campus),
Authorized Letter from Spouse/ Parent ( if vehicle is not belong to you )
Photocopy of your I/C @ Workers Pass, Valid Driving Licence, Vehicle Registration Card Offer Letter
and Authorized Letter with this application form. ( Contractor, Business, Consultant ,Part time )

For Renewal :- Please attach the old sticker with this form ( Contractor, Business, Consultant, Part time )
( Car only ) For student only please refer to the new application .
# Motorcycle sticker photocopy of the matric card and road-tax

PARTICULAR OF VEHICLE

Vehicle Registration No. Vehicle Registration No.

1 2

Type of Car / Motorcycle ( model ) Type of Car / Motorcycle ( model )

Colour ( Vehicle ) Colour ( Vehicle )

__________________
Date :
Applicants Signature

Recommendation from the Mahallah Principal / CPS


Head of Dept./ FFSD/ DEV / IIUM Holdings / Dept / Kull
Signature / Stamp Stamp
( New Application / Renewal Student, Contractor, Business, Consultant, Part time )
Student are not allowed to park their vehicle ( car ) at the Kulliyyah, Department, __________________
Centres and Institute parking spaces ( During office hours ) Signature

For Office Use


Car / Motorcycle Sticker Number
Applicant approved / not approved
1
Remarks : ___________________________ ___________________________________
Car / Motorcycle Sticker Number
Senior Security Officer / Security Officer /
2 Senior Security Guard
Date :
Office Of Security Management

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