LIBRARY MATERIALS LOSS/ DAMAGE REPORT FORM
Loss/ damage books that you borrowed from USIM Library? Please fill the form and we will get back to you as soon as we can.
Any inquiries please contact us via
OR 067986248/ 6226/ 6249
Mdm. Suharti Tulos: 0172371577
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1. PERSONAL INFORMATION
1.3 Staff/ Student Number :
1.4 IC MyKad/ Passport Number :
1.5 Department/ Faculty:
1.6 Email address :
1.8 Phone No.:
2. INFORMATION OF LOST LIBRARY MATERIALS
Please submit another forms if loss more than one book (1 Form per Book)
Please login to your account to get the item description at
2.1 Book Title :
Please submit another forms if more than one book (1 Form per Book)
2.3 Barcode No:
By clicking YES and SUBMIT, you are agreed for USIM Library to use this information as a representatives of yourself for reporting the loss of library materials in your loans. No signature is needed. USIM Library will be using this information as an evidence to charge the requirement amount for the price of materials and service charge by following the USIM Library Fine Policy.
NO (I want to go to USIM Library to fill up printed forms)
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