INTERNATIONAL ACCOMMODATION APPLICATION FORM

Section 1 - Applicant Details

√ Student Lecturer Others

Name:
Gender: Male Female D.O.B - -
Passport No. Expiry Date: - -
Address:
Country: Postcode:
Nationality: Student ID:
Tel No. Email:
Medical Illness (If Any)

Section 2 - Emergency Contact

Name Relationship:
Contact no. Email:

Section 3 - Institution Details

UBD UTB Politeknik Others

Programme
Length of Course

Section 4 - Check-In/ Check-Out Information

Check-In Date - - Check-In Time

Check-Out Date - - Check-Out Time

Section 5 - Accommodation Selection

The Core $250.00/monthly (Shared Apartment - 1 Room + Shared Living Room, Bathroom, Kitchen )

M4 - Family Quarter $650.00/monthly (1 Master Bedroom + 2 Room + Bathroom + Kitchen)

IBER $650.00/monthly (1 Master Bedroom + Living Room + 1 Room + Bathroom + Kitchen)

Executive House $2500.00/monthly (1 Master Room + 1 Living Room + 3 Rooms + 2 Bathroom + Kitchen)

Other Arrangements

Section 6 - Transportation Request

Do you require airport pickup? Yes No
If Yes please tick $ 30 (From Airport to Accommodation)
Section 7 - Flight Itinerary Information

Date of Arrival - - Time of Arrival

Country of Departure Flight No.

Section 8 - Payment Details

Payment by Self Charge to Institution

Payment type Cash Others

STUDENT AFFAIRS OFFICE USE ONLY

Confirmation of payment will be made by the Institution (Refer to Section 8) Yes No

Acknowledge by:
Name:

Department:

Signature: Date:

Notes:
* Please provide a copy of passport, offer letter and flight itinerary of applicant.
* Incomplete details will not be process.