IIUM/LIB/03/f-01

IIUM LIBRARY Rev. No. : 05

MEMBERSHIP APPLICATION Effective Dt : 01/06/2016

STAFF
STUDENT
------------------------------------------------------------------------------------------------
- NEW APPLICATION

MEMBERSHIP STATUS CHANGE APPLICATION

Borrower Barcode #: _____________________________ PIN (6 digits):

(Note: This is a MUST to enable you to use the
Self-service borrowing & returning machines,
ICT facilities & access to digital library services)

*Staff/Student Matric Card#:_________________________ *Post/Programme: ________________________

Name: ___________________________________________________________________________________

Department & Kulliyyah: ___________________________________________________________________

ID/Passport #: ______________________________________ Nationality: ____________________________

E-mail address: _____________________________________ Handphone #: __________________________

*Delete where not applicable

Contact address: ___________________________________________

(Hostel’s address
if you are staying _________________________________________________________________
at IIUM’s hostels
___________________________________________

Home address: ___________________________________________

(Home country)
_________________________________________________________________

_________________________________________________________________

NOTE OF UNDERTAKING
By signing this form, I agree to comply with all the Library Rules and Regulations.

_____________________________________________________________
Signature Date

FOR OFFICE USE

Application received by: Initial: ___________________________ Date: _________________

Membership record updated
and/or * barcode processed by: Initial: ___________________________ Date: _________________
CSD/SHD/NAP..08052014;SMSH/smsh09.06.16