borang permohonan penggunaan peralatan ... - Universiti Malaya

SECTION I: USER DETAILSBOOKING AND USAGE FORM FOR HIR CENTRAL FACILITIESNote: Please tick (√) on appropriate boxDate: ____________________Equipment NameUser Name: __________________________________________________________: __________________________________________________________Institution Name : UM Others Please specify : ________________________Department/Faculty: __________________________________________________________Address (External User) :____________________________________________________________________________________________________________________User Has Experience Handling the Equipment?: YES NOTelephone No. : _________________________ (O) ________________________(H/P)Email Address : __________________________________________________________Name of Principle Investigator/Grant Holder (if applicable): ________________________________Sources of Grant : HIR Non HIR Please specify : _________________________Grant Reference No. : ____________________ Grant Account No. : _____________________________________________________________________________________________________________________________________________SECTION II: BOOKING DETAILSDate : ____/______/______ (Time) From: __________ To:___________Total charges : RM________ x _______ samples/hours/slot = RM______________(Please refer to Lampiran 2)Special Request : ________________________________________________________________(Subject to availability)Terms and Condition:1. 50% Advance Payment must be made to HIR Account; J-50001-76533 at least three(3) working days prior to scheduled date.2. Failure to pay on time will result in the cancellation of your booking.3. Booking cancellation must be done at least three (3) working days before the scheduled date.4. Advance payment will be forfeited for any cancellation made less than 3 working days prior to the scheduled date.User’s Name/Signature/Stamp :Date:_____________________________________________________________________________________________________________________SECTION III : HIR LAB USE ONLYBooking Reference No.Total ChargesMode of Payment: HIR/EQ/___/___: RM______________: Journal/Cheque/Telegraphic Transfer/Purchase OrderApplication Status : Approved Not ApprovedOfficer’s Signature & Stamp :Date:

BOOKING AND USAGE FORM FOR HIR CENTRAL FACILITIESSECTION IV : HIR SECRETARIAT USE ONLYBooking Reference No.: HIR/EQ/___/___Sources of Grant : HIR Non HIR Please specify : __________________Grant Reference No.Grant Account No.Total Charges: ___________________________________________________: ___________________________________________________: RM______________Account Status: Sufficient / Not Sufficient / Not availableMode of Payment: Journal/Cheque/Telegraphic Transfer/Purchase OrderAdvance Payment (50%): RM______________Invoice No. : ________________________ Date : _____________________Payment Reference No. : ________________________ Date : _____________________Application Status : Approved Not ApprovedOfficer’s Signature & Stamp :Date:------------------------------------------------------------------------------Balance Payment: RM______________Invoice No. : ________________________ Date : _____________________Payment Reference No. : ________________________ Date : _____________________Officer’s Signature & Stamp :Date:______________________________________________________________________________________________________________________SECTION V : CANCELLATION REFUND DETAILSBooking Reference No. : HIR/EQ/___/___Grant/Bank Detail: ______________________ Account No. : ______________________Amount refunded: RM______________Mode of Payment: Journal (Internal) /Telegraphic Transfer (External)Refund Reference No. : __________________________________________________________Officer’s Signature & Stamp :Date:

JADUAL KADAR SEWA BAGI PERALATAN HIR, UNIVERSITI MALAYALAMPIRAN 2