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I-ENVEX Hostel Application Form
CONTACT INFORMATION
IPT/Technical Institute/ School :
Name (Mr/Mrs/Ms) :
Mobile Contact Number:
Office Contact Number:
Fax Number:
Email:
Full Address:
ACCOMMODATION INFORMATION
Check In Date :
Check In Time :
Check Out Date:
Check Out Time
GUESTS INFORMATION
Guest Information :
Male
Female
Number of Staff
Number of Driver:
Number of Student :
Total Guest :
Do you need transportation from the airport to the hostel?
Flight Number :
Time :
APPROVAL (FOR OFFICE USE ONLY)
Approved
Application Status:
Not Approved
Approved By :
Date :
Payment Method:
Cash
Hostel Address:
Kolej Kediaman UniCITI ALAM,
Universiti Malaysia Perlis,
Sg. Chuchuch
02100 Padang Besar,
Perlis
ITEM
I Envex Hostel Rate
Check In 17 April 2015
Check Out 19 April 2015
:
Hostel Management Office
STUDENT/STAFF
RM 50 /3Day 2 Night

Including 6% GST
Completed applications form must be submitted to i-Envex Secretariat on or before March 31st, 2015 at 4 pm by fax (04-9852232
) or email to ( fadzliah@unimap.edu.my). For any enquiries, please contact us at 04-9852231 ( Pn. Nur Fadzliah) or 04-9851535
( Pn. Hasmi).