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FA-AD3.2003FIXED ASSET UNIT
Declaration For Damage / Repair / Lost / Stolen of Asset Form
Category Staff / Student / Others :Name IC / ID No.:Department / Faculty Contact No: E-mail Address
DESCRIPTION OF EQUIPMENT / ASSET
No Item / Equipment Quantity Asset Tagging Number
Serial Number Damages(*)
Lost(*)
* Please tick whichever is applicable
Reported By: Verified By :(Cost Center / Asset Liaison Officer)
Confirmed By:(Dean / Director / Head)
Date, Signature & Stamp Date, Signature & Stamp Date, Signature & Stamp** Fixed Asset Unit : ** Security :
Date, Signature & Stamp Date, Signature & Stamp** These columns are applicable if the items are to be sent outside of the campus only.
Copies to :
1. Fixed Asset Unit2. Security (Stolen / Lost)
Sysy/declarationform
Page 1 of 1Multimedia University,
Jalan Ayer Keroh Lama, 75450 MelakaTel: 606-252 3167
Jalan Multimedia, 63100 Cyberjaya, SelangorTel: 603-83125966
