borang permohonan penggunaan peralatan ... - Universiti Malaya

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: