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Research Parking Space Request Form
Limited space, priority will be based on first come first serve.
PARKING LOT LOCATION:
Vistor Parking Lots,
Dental Specialist & Research Tower,
Faculty of Dentistry, UM
Coordinate: @3.1111264,101.6535646
https://goo.gl/maps/ebh9NTsm7N12
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TERMS AND CONDITION
*
Compulsory to tick (√) this column prior to proceed for the next page:
I acknowledge that I have read and agree to the above terms and conditions and i accept it with full knowledge of its effect.
Required
Full Name
*
Your answer
Requester's Email
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Your answer
Position:
*
Supplier
Academic Staff
Research Assistant
Supporting staff
Other:
Institution/ Company/ Department/ Faculty
*
Your answer
Mobile No
*
Your answer
Vehicle Type/ Model
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(Exp: Proton Saga/ Honda/ Nissan etc)
Your answer
Registration No.
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Plate number
Your answer
Vehicle colour
*
Your answer
Parking Date
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day/month/year
Your answer
Time – in
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time/12hours
Your answer
Time – out
*
time/12hours
Your answer
Reason for Applying
*
State your reason for the application
Your answer
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