Danish House Sdn. Bhd.

APPLICATION FOR ACCOMMODATION

For office use only

Single Room RM
House Type :

Double Room RM Room No . :

Triple Room RM
Tenant ID : Tenant A/C Code :

Intake : Notes : -Please fill form in BLOCK LETTERS

(eg. : May/08) -Must be completed from section A to C especially which are marking *
A. PERSONAL DETAILS

HengZhengPhin 王丞斌
1. *Full Name : 中文姓名 :
(As in I.C. / Passport)

2. *I.C. No. (new) / Passport No : 000601081003 3 . *Sex : M

4. *Date of Birth : 1 / 06 / 2000 5 . Nationality : MALAYSIA

dd mm yy

6. Married Status : Single / Married / Others : single

7. *Race :
Chinese 8 . Religion : Buddha

9. Occupation : Student Please attach 2 photos

- If student state : Course of study : Software Systems Development

Place of study : TARUC kampar branch

- If non student state : Name of company :

Address of company :

Position held :

10 . Hometown Address :
Heng Zheng Phin 王丞斌

No 185 Persiaran Melor, 2, Fasa 3, Taman Melor, 36000 Teluk Intan, Perak
 11 . Correspondance Address (If different from hometown address)

12 . *Email Address : hengzp2000@gmail.com

13 . *Contact No. : (H/P) 0169371003 (H) (O)

14 . Are you in good health ? Yes

If no, please provide further details

( e.g: Asthma, Epilepsy, Heart attack, Psychological problem )

B. PERSON TO CONTACT CASE OF EMERGENCY

(I) *1st Guardian

1. Full Name : Tee chu goon Relationship : Mother

2. Address : No 185 Persiaran Melor, 2, Fasa 3, Taman Melor, 36000 Teluk Intan, Perak

3. Contact No. :

(H/P) 0103701678 (H) 05-6213435 (O)

(II) *2nd Guardian

1. Full Name : Heng Chu Chin Relationship : Brother

2. Address : No 185 Persiaran Melor, 2, Fasa 3, Taman Melor, 36000 Teluk Intan, Perak

3. Contact No. :

(H/P) 0103794988 (H) (O)

C. DECLARATION AND SIGNATURE

THE UNDERSIGNED, HEREBY :

I . Declare that the above information given by me is true and complete .

II . Understand that this accommodation application is subject to room availibility and the management
reserves the right to assign any other type of accommodation available .

III . Agrees to abide by all Accommodation Rules and Regulations, which is subject to update and changes from
time to time .

IV. Residents is subject to the term and conditions as stipulated in the contract provisions.

Signature of Applicant : heng Date : 18/3/2022

 For office use only

ACKNOWLEDGE RECEIVED OF BOOKING CONFIRMATION LETTER

3. Date of Received:
Full Name of Recipient:
1.
2. 4. Signature of Recipient:
Contact No. of Recipient: