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INTERNATIONAL ACCOMMODATION APPLICATION FORM
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Section 1 - Applicant Details
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√StudentLecturerOthers
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Name:
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Gender:MaleFemaleD.O.B--
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Passport No.Expiry Date:--
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Address:
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Country:Postcode:
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Nationality:Student ID:
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Tel No.Email:
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Medical Illness (If Any)
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Section 2 - Emergency Contact
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NameRelationship:
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Contact no.Email:
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Section 3 - Institution Details
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UBDUTBPoliteknikOthers
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Programme
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Length of Course
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Section 4 - Check-In/ Check-Out Information
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Check-In Date--Check-In Time
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Check-Out Date--Check-Out Time
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Section 5 - Accommodation Selection
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The Core $250.00/monthly (Shared Apartment - 1 Room + Shared Living Room, Bathroom, Kitchen )
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M4 - Family Quarter $650.00/monthly (1 Master Bedroom + 2 Room + Bathroom + Kitchen)
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IBER $650.00/monthly (1 Master Bedroom + Living Room + 1 Room + Bathroom + Kitchen)
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Executive House $2500.00/monthly (1 Master Room + 1 Living Room + 3 Rooms + 2 Bathroom + Kitchen)
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Other Arrangements
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Section 6 - Transportation Request
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Do you require airport pickup?YesNo
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If Yes please tick$ 30 (From Airport to Accommodation)
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Section 7 - Flight Itinerary Information
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Date of Arrival--Time of Arrival
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Country of DepartureFlight No.
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Section 8 - Payment Details
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Payment bySelfCharge to Institution
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Payment typeCashOthers
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STUDENT AFFAIRS OFFICE USE ONLY
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Confirmation of payment will be made by the Institution (Refer to Section 8)
Yes
No
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Acknowledge by:
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Name:
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Department:
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Signature:Date:
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Notes:
* Please provide a copy of passport, offer letter and flight itinerary of applicant.
* Incomplete details will not be process.
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