LIBRARY MATERIALS LOSS REPORT FORM
Loss 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 sirkulasi@usim.edu.my OR 067986248/ 6226/ 6249
1. PERSONAL INFORMATION
1.1 Date: *
MM
/
DD
/
YYYY
1.2 Name: *
1.3 Staff/ Student Number : *
1.4 IC MyKad/ Passport Number : *
1.5 Department/ Faculty: *
1.6 Email address : *
1.7 Mailing 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 http://kohalib.usim.edu.my/
2.1 Book Title : *
Please submit another forms if more than one book (1 Form per Book)
2.2 Author/ Editor: *
2.3 Barcode No: *
2.4 Call Number:
(i.e: BP 165.7 .Y34 2011)
2.5 Publisher:
Leave blank if not sure
2.6 Year of Publication:
Leave blank if not sure
USERS AGREEMENT *
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.
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