Management and Science University

(Formerly known as University College of Technology & Management Malaysia, KUTPM)

ACCOMMODATION APPLICATION FORM

Please complete and return this original application form with all the appropriate supporting documents to: Graduate Management Centre (GMC) Management & Science University (MSU) Level 4, West Wing Stesen Sentral Kuala Lumpur 50470 Kuala Lumpur. Malaysia. Tel: 60 3 2273 6410 Fax: 60 3 2273 641 Website: www.msu.edu.my Email: gmc@msu.edu.my SECTION 1 : PERSONAL DETAILS Answer questions in all relevant sections. Write clearly in black ink using BLOCK LETTERS and tick boxes where appropriate. We cannot consider your application if it is incomplete or unreadable. Name as per passport

Mr. Ms. Miss Mrs. Others, please specify: _________________

(Please affix a passport sized photo here)

Please underline your family name Identity Card No/ Passport No. Gender

Male Female

Date of Birth
D D M M Y Y Y Y

Nationality Race Permanent Address in home country (courier delivery is not possible with P.O Box number) City: Postcode Telephone -Country Code -Country Code Email

Marital Status

Single

Married Others

State: Country -Area Code -Area Code Mobile Number Residential Number

Page 1 of 2 Application for Accommodation

Management and Science University

(Formerly known as University College of Technology & Management Malaysia, KUTPM)

SECTION 2 : TYPE OF PREFERRED ACCOMODATION Please tick ( ) your preferences. We cannot guarantee that we can accommodate all your needs but we will try our best. Budgeted Room Rental Per month Arrival Date & Time Preferred Type of Room (per person)

Single Room Twin Sharing

RM500 and below RM501 RM1000 RM1001 and above

Date: Time: Pick up service:

Yes

No

This service is provided for International students only. For Malaysian Student, you need to pay the pick-up service charges)

Other special requirements:

SECTION 2 : PERSON TO CONTACT IN CASE OF EMERGENCY Name of Contact Person Contact Number
Country Code

-Area Code

-Residential Number

-Country Code Area Code

-Mobile Number

Relationship

SECTION 3: DECLARATION
I understand and confirm that this accommodation application is subject to room availability and that MSU and its Agent reserves the right to assign any other type of accommodation available. I declare that I have read the instructions on this application form and that the information provided by me in this application is true and complete in every particular. I authorise MSU to release personal information relevant to my application and visa documentation to the official agent of the Management & Science University.
Signature: Date: Name & IC/ Passport No:

For Office Use Received by Payment Received Bankdraft/ Cheque No: Amount Received: Application Processed by: Agent: Contact Person Contact Numbers Date Received

Page 2 of 2 Application for Accommodation