Caution Money Form

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Return to:

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UNIVERSITI TUNKU ABDUL RAHMAN

Faculty General Office
L-.rrrversirr Tunr<u Aboul Ranmar l APPLICATION FOR REFUND OF CAUT]ON MONEY , For Office Use
. MALAYSTAN STUDENTDate Received

Onlv

Signature

Section A - To Be Completed By Student
(Please complete appilcation form in BLOCK LETTERS throughoui except email address.)
New l/C No
Registration No
Contact Tel No ;

Student Name (as per l/C)
Course of Study
Email Address:

:

:

I have * completed / wiihdrawn from the course and left the Universiiy on
(ii) I am not in arrears of fees.
(iii) | have returned all articles belonging to the Unrversitv including library books.

(i)

(cjate)

(iv) i have settled all otheroutstanding iiabilities (e.g. breakages/loss to laboratory equtpment, etc..
(v) I have not claimed any refund of caution monev before.

(b)

I

)

wish to applyr for the refund of my caution money as ticked [r/ ] beiow:

-r]

Foundation/Bachelor/Master/PhD Programme

(RM200.00)

[l

MgAS Programnre (RMs00.00)

to UTAR Siudent Loan Fund to help needy students to achieve their goal

I wish to donate RM in attaining tertiary education.

I wish to authorise the University to refund my caution money through the arrangement that I have ticked (r1) at the appropriate box provided.

Refund of Caution Money Arrangemenl:

(i) fl

l

Deposit inio my Public Bank Aecount No
Deposit into my other bank account maintained in the UTAR Siudent Porial,

lmpoftant:
Please ensure you have maintained your bank account information in the UTAR Student Portal before submitting this application form for refund of caution money, Otberwise, the University is nat able fo process the refund of caution money to you'

Signature

Section B . To Be Completed By Faculty
I certify that this studeni has: (P/ease tick

i-I

ti iwhichever

is applicable.)

Completed,&Vithdrawn frorn the couise and left the University
Caused breakages and damage to the iab equipment

Replacement Cost (RM)

Items
1

2

Authorised Signature &