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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
Student On Campus
Dept. / Kull ( Staff / Student ) Mahallah : ( Student ) Room No :
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
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
1 2
__________________
Date :
Applicants Signature