Clearance Form

CLEARANCE FORM You are required to see the Officer In-charge from various Departments/Centers/Divisions to get clearance and approval. The form must be returned to Finance Division once it is complete. Student ID:

………………………………. Faculty: …………………………..

Name :

………………………………………………………………………

LIBRARY DIVISION 1.

2.

Unreturned Library Book (s): i)

……………………………………………………………………….

ii)

……………………………………………………………………….

iii)

……………………………………………………………………….

iv)

……………………………………………………………………….

Unpaid late Penalties/Compound: RM …………………………….

Officer In-charge approval:

………………………………………… Name/Stamp: Date: SECURITY DEPARTMENT 1.

Unpaid traffic Compound (in-campus): RM …………………………….

2.

Disciplinary Cases (unpaid compound): i)

……………………………………………………………………………

ii)

……………………………………………………………………………

3.

Others: i)

……………………………………………………………………………

ii)

……………………………………………………………………………

Officer In-charge approval:

…………………………………………….. Name/Stamp: Date FINANCE DIVISION 1.

Outstanding balance of: i)

Tuition Fee: RM …………………

ii)

Hostel Fee: RM …………………..

iii)

Others: a)

…………………………………………………………………

b)

…………………………………………………………………

c)

…………………………………………………………………

Officer In-charge approval:

…………………………………………… Name/Stamp : Date :