STUDENT VILLAGE WITHDRAWAL FORM

Accommodation
STUDENT VILLAGE WITHDRAWAL FORM

PLEASE FILL IN THIS FORM IF YOU NO LONGER STAYING AT STUDENT VILLAGE. THIS FORM IS TO BE SUBMITTED WITH REFUND REQUEST AND BANK DETAILS DOCUMENTS.
Refund Request Form and Authorisation Letter can be obtained here (Student Forms - Others) https://www.swinburne.edu.my/wp-content/uploads/so-media/docs/forms/Refund-Request-Form-Version-2022.pdf
Finance Refund Request form *

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Cancel of
Bank Details screenshot/ copy of bank statement *

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Receiver's Bank Details screenshot/copy of your bank statement/online banking webpage)
Cancel of
Authorization Letter (If you are using 3rd party account and recipient)

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Cancel of
RESIDENT'S INFORMATION
Given Name *
Family Name/ Surname
Student ID No. *
Student Email. *
Mobile Number *
NOTICE OF WITHDRAWAL FROM STUDENT VILLAGE

REFERENCE TO YOUR BOOKING CONFIRMATION YOUR CHECK OUT DATE IS END OF YOUR TENURE.
Building *

SV2 Female block SV3 Male block
Room Number *
Number only
Your current room options

Standard Single (Single with Fan) - RM850 per month Standard Twin (Twin Sharing with Fan) - RM490 per month Standard Plus Single (Single with Air Conditioning) - RM1200 per month Standard Plus Twin (Twin Sharing with Air Conditioning) - RM900 per month
My withdrawal reason *

End of Tenure Personal Reason Complete study Other
My Check Out Date *

Month Day Year
Please note that your check out time is 12noon.
Account to refund *

Your personal account 3rd party account
RESIDENTS CHECKLIST TO CHECK OUT AND REFUND *

Submit Hostel Withdrawal Form Deposit refund to resident. Attached along resident's Bank Details screenshot/copy of your bank statement/online banking webpage) Refund Request Form Return Access Card I HAVE COMPLETED THE CHECKLIST ABOVE Other
RESIDENTS CHECKLIST TO CHECK OUT AND REFUND *

Submit Hostel Withdrawal Form Deposit refund to 3rd party account (1) Authorization Letter from Resident (2) attached along authorized person's Bank Details screenshot/copy of your bank statement/online banking webpage) Refund Request Form Return Access Card I HAVE COMPLETED THE CHECKLIST ABOVE Other
Refund of the rental deposit will be subject to the Hostel’s Terms & Conditions. The refund process may take up to 4 weeks starting from your current end of Tenure Period.

STUDENT’S DECLARATION (Please use Fill & Sign)

I affirm that the documents are complete and the information contained within this form is correct. The university shall not be responsible for any loss due to misinformation provided and incomplete documents.
Student signature
Date

Month Day Year
Date
GENERAL PRIVACY STATEMENT
Swinburne University of Technology Sarawak Campus collects, uses and destroys personal data in accordance with our Privacy Collection Notice at https://www.swinburne.edu.my/privacy/privacy-collection-notice

ROOM CLEARANCE AFTER CHECK-OUT (for office only)
PLEASE PROCEED TO CLICK SUBMIT BUTTON
FOR OFFICIAL USE ONLY - WARDEN / ACCOMMODATION STAFF

THIS SECTION TO BE COMPLETED BY STAFFS
Bed divan

Good Condition Need repair Defect found Other
Bed side cabinet

Good Condition Need repair Defect found Other
Study table and chair

Good Condition Need repair Defect found Other
Blind/ Curtain

Good Condition Need repair Defect found Other
Wardrobe

Good Condition Need repair Defect found Other
Wall Cabinet

Good Condition Need repair Defect found Other
Door access card

Return Lost Other
Ceiling Fan

Good Condition Need repair Defect found Other
Room Lighting

Good Condition Need repair Defect found Other
Air-Condition

Good Condition Need repair Need cleaning Not applicable
Wall surface

Good Condition Need repair Defect found Other
Room cleanliness

No leftover / mess Room left in messy/dirty condition
Penalty Imposed (RM)
DEDUCTION FROM ROOM DEPOSIT. ANY CHARGE TO REPAIR / CLEANING DURING TENURE WILL BE BEARED BY THE RESIDENT
Utility charges (RM)
DEDUCTION FROM RM500 UTILITY DEPOSIT
Verified by:
Date

Month Day Year
Date
APPROVAL FOR WITHDRAWAL & REFUND (for office only)
Should be Empty:

Accommodation

STUDENT VILLAGE WITHDRAWAL FORM

RESIDENT'S INFORMATION

NOTICE OF WITHDRAWAL FROM STUDENT VILLAGE

GENERAL PRIVACY STATEMENT

PLEASE PROCEED TO CLICK SUBMIT BUTTON

FOR OFFICIAL USE ONLY - WARDEN / ACCOMMODATION STAFF