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ON-CAMPUS STUDENT ACCOMMODATION APPLICATION FORM

(FOR SEPTEMBER 2013 INTAKE ONWARDS ONLY)





Please use block capitals.
Student application no. : UNIMKL-___________________
Family name : _________________________ First name :
Passport /IC no : ____________________________ Date of Birth :
Gender : Male Female
Marital status : Single Married
Home address :
___________________________________________ Postcode :
Home Telephone : _________________________ Mobile :
Fax : _________________________
Correspondence address (if different from above):

E-mail :
Course :
Intake :

APPLICANTS/STUDENTS MUST READ AND AGREE TO THE FOLLOWING TERMS AND CONDITIONS OF
THE APPLICATION FOR THE ON-CAMPUS STUDENT ACCOMMODATION APPLICATION BEFORE
COMPLETING THIS APPLICATION FORM:

1. Submission of the on-campus students accommodation application form and acceptance fees will not result
in rooms being allocated until an offer to study has been issued by the university.

2. Accommodation Office reserves the right to reject any incomplete application form.

3. Students are advise to indicate their preference of rooms at least 5 choices with 1 being the preferred room.
Application will NOT be processed if indication of rooms preference is less than 5 choices.

4. All terms and conditions above are subject to change without prior notice.

STATEMENT OF UNDERSTANDING

I, _________________________________ (NRIC/Passport No. :_____________________) hereby have
read, understood, agreed and accepted the contents of the above terms and conditions.


___________________________
Applicant /Students Signature
Full Name :



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FOR NEW STUDENTS ONLY
Accommodation Office will only consider the application for on-campus student accommodation
upon confirmation of students accepting the offer and upon receipt of the ACCEPTANCE FEES.
Rooms will not be allocated until receipt of ACCEPTANCES FEES. Students are encouraged to pay
the Acceptance Fees early in order to secure your rooms. The University reserves the right to
allocate a room from your list of preference. Should there be no room available from your list of
preference the University will inform you accordingly. Have you accepted the offer to study at
The University of Nottingham Malaysia Campus?

Yes (Please attached the official receipt of Acceptance Fees with this form for verification purpose)

No













Please indicate the following information if you apply your study programme through
university appointed agent.
Agent Company Name : _________________________________________________________
Person incharge Name : _________________________________________________________
E-mail : _____________________________________________________







Choice Of On-Campus Student Accommodation (Please list your preference, with 1 as your
top preference) HALLS OF RESIDENCE (with estimated floor area)
Deluxe Single Ensuite Bathroom with air-conditioning @RM850 per student (inclusive of Wifi
internet but with separate meter for air-conditioning usage payable by student).15.15m
2
per room

Single Ensuite Bathroom with air-conditioning @RM680 per student (inclusive of internet connection
but with separate meter for air-conditioning usage payable by student). 13.23m
2
per room.
Single Shared Ensuite Bathroom with air-conditioning @RM615 per student (inclusive of internet
connection but with separate meter for air-conditioning usage payable by student). 12.96m
2
per
room.
Single Shared Ensuite Bathroom @RM510 per student (inclusive of internet connection). 12.96m
2

per room.
Single Shared Bathroom in 5 Room Flat with air-conditioning @RM585 per student (inclusive of
internet connection but with separate meter for air-conditioning usage payable by student).
9.487m
2
per room.
Single Shared Bathroom in 5 Room Flat @RM480 per student (inclusive of internet connection).
9.487m
2
per room.
Twin Share in 6 Bedded Flat @RM455 per student (inclusive of internet connection).
12m
2
per room.
Four Shared Bathroom @RM395 per student (inclusive of internet connection). 48.24m
2
per room.
Double Decker Shared Ensuite Bathroom with air-conditioning @RM470 per student (inclusive of
internet connection but with separate meter for air-conditioning usage payable by student).
13.23m
2
per room.
Double Decker Shared Ensuite Bathroom @RM415 per student (inclusive of internet connection)
13.23m
2
per room.

(Revised May 2013) Page 3 of 3




FOR STUDENTS WITH DISABILITIES / SPECIFIC REQUIREMENTS ONLY :
Accommodation Office will NOT consider your request thereafter if you do not indicate
your specific requirements in this form.
To help us in allocating your accommodation, please indicate any special arrangements that you will need
(e.g. assistance required, ground floor room, etc.)

DECLARATION:- Students must read, fully understand and agree to the attached all terms,
rules and regulations and the law of Malaysia before signing this form.

Signature of Applicant: Date : __________________________
For submission of On-Campus Student Accommodation Application Form, please fax or e-
mail to: Fax: +6(03) 8924 8657 or E-mail: [email protected]

FOR ACCOMMODATION OFFICE USE ONLY

Received By : Received Date:
(Name & Signature)

Hall & Room Assigned By: Date Assigned:
(Name & Signature)


Payment Received By : Date Received:


Payment Received By Finance Office :
(Name & Signature)

Room Confirmed By : Date :
(Name & Signature)

Application Completed Date :

FOR FINANCE OFFICE USE ONLY

Payment Received By : _____________________ Date Received : ______________

Official Receipt No : _____________________