Universiti Tunku Abdul Rahman
Form Title: Application to use UTAR’s Laboratory Facilities & Equipment (Non-UTAR Staff/Student)
Form Number: FM-LKCFES-LMC-009
Rev No: 00 Effective Date: 21/10/2015
Page No: 1/2
1) Applicant Detail
Name
IC No.
Contact No.
Email Address
Department/Course
Institution
Collaborator(s) in
UTAR
Signature
Date
2) Description of Request
Name of Laboratory
Date
Room No.
From
to
Equipment involves
Description of work
(Detailed Description
Please attach additional sheet
if room not enough)
3) Approval
Supported by
Collaborator in UTAR
Acknowledged by
Lab Staff
Agreed by
Lab Supervisor
Approved by
HOD (DLMSA)
Signature :
Signature :
Signature :
Signature :
Name
:
Name
:
Name
:
Name
:
Date
:
Date
:
Date
:
Date
:
Universiti Tunku Abdul Rahman
Form Title: Application to use UTAR’s Laboratory Facilities & Equipment (Non-UTAR Staff/Student)
Form Number: FM-LKCFES-LMC-009
Rev No: 00 Effective Date: 21/10/2015
Page No: 2/2
Rules & Regulations
a) Application form must be submitted at least 7 working days prior to application date.
b) Applicant is required to read, understand and agree to “LKC FES Laboratory Guidelines”.
c) Different laboratory may have different set of rules and regulations, applicant is required to check with laboratory
staff in charge for its specific rules and regulations before commencing any work.
4) Declaration
I _________________________________, of IC No. __________________________, have fully read and understand
the above rules and regulations and agree to abide by them. I agree to hold full responsibility in case of any damages
caused in the corresponding laboratory pertaining to the equipment and/or other properties of the university during my
usage of the lab.
Signature
________________________
Date :