AV Equipment Loan Request Form Reference No.Applicant DetailsCategory--select--StaffStudentStudent ID No. Full Name(Required) E-mail(Required) Contact No.(Required) Faculty / Centre / Office / Unit--select--Faculty of UsuluddinFaculty of ShariahSultan Haji Hassanal Bolkiah Faculty of LawFaculty of Arabic LanguageFaculty of Islamic Economics and FinanceFaculty of Islamic Development ManagementFaculty of Islamic TechnologyFaculty of AgricultureCentre for Research and Publication (UNISSA Press)Centre of International and Public RelationsTechnology and Multimedia CentreCentre for Leadership and Lifelong LearningCentre for Graduate StudiesHalalan Thayyiban Research CentreMazhab Shafi’i Research CentreCentre for Promotion of Knowledge and LanguageIbnu Sina Laboratory CentreCentre of Islamic Manuscripts StudiesRector OfficeDeputy Rector (Policy & Corporate) OfficeRegistrar OfficeBursar OfficeStrategic Planning and Development OfficeOffice of Career Advancement and Industrial NetworkingLibraryEstate OfficeStudents Affairs OfficeAlumni Affairs OfficeInformation Technology Unit (under Technology and Multimedia Centre)Education Technology Unit (under Technology and Multimedia Centre)Counseling UnitResidential College UnitHealth, Safety, Security, and Environment UnitStudent Welfare UnitEvent / Class DetailsLoan Purpose--select--TeachingLearning [Presentation]Internal Event UNISSAExternal Event UNISSALoan Duration [Number of hours / days] Class [Course Code & Course Name] Title [Event] Date [Event / Class] DD slash MM slash YYYY Venue [Event / Class] Start Time [Event / Class](Required) Hours : Minutes AM PM AM/PM End Time [Event / Class] Hours : Minutes AM PM AM/PM Equipment Loan DetailsPortable P.A System with Wireless Microphones 1 set [Portable P.A System with Wireless Microphones] 2 sets [Portable P.A System with Wireless Microphones] Stand P.A System Speaker 1 set [Stand P.A System Speaker] 2 sets [Stand P.A System Speaker] Mondopad 1 set [Mondopad] 2 sets [Mondopad] TV 1 set [TV] 2 sets [TV] Table Stand Microphone 1 set [Table Stand Microphone] 2 sets [Table Stand Microphone] Stand Microphone 1 set [Stand Microphone] 2 sets [Stand Microphone] Walkie-Talkie 1 set [Walkie-Talkie] 2 sets [Walkie-Talkie] 3 sets [Walkie-Talkie] Aver Video Camera 1 set [Aver Video Camera] 2 sets [Aver Video Camera] Power Cable Extension 5m 1 set [Power Cable Extension 5m] 2 sets [Power Cable Extension 5m] 3 sets [Power Cable Extension 5m] Other RemarkUNISSA HALLUNISSA Hall Auditorium Jubli Hall Auditorium P.A System LED Screen Microphone No. of Microphone Needed [Auditorium] 1 set [No. of Microphone Needed | Auditorium] 2 sets [No. of Microphone Needed | Auditorium] 3 sets [No. of Microphone Needed | Auditorium] Other Jubli Hall P.A System Projector Microphone No. of Microphone Needed [Jubli Hall] 1 set [No. of Microphone Needed | Jubli] 2 sets [No. of Microphone Needed | Jubli] 3 sets [No. of Microphone Needed | Jubli] Other Consent(Required) I agree to return the audio/video equipment promptly in good condition after use and accept responsibility for any damages, losses, or delays. I acknowledge that I have read and agree to the terms and conditions.HiddenOfficial Use [Collection Details]HiddenStatusRequestedDeployedReturnedHiddenCollect by [Full Name] HiddenStudent ID No. HiddenCollection Date DD slash MM slash YYYY HiddenRelease By [TMC Staff]--select--Dr Hj Md Abul Fadle bin Hj Maidin / Hj MohiddinHaji Huzairi Bin Haji AjiDk Nazhatul Shahima Binti Pg HassanMohammad Ashadi Bin JamanMohammad bin Awang Haji KassimHaji Faritz Azirul Bin Haji RamlieHaji Mohd Nazmi Bin Haji AzahariMohammad Norhadi Bin Awang AhmadMohammad Arrafie Bin HassanSiti Amafina Binti Haji ZamanSiti Nursaaliah Binti AbdullahPg Shah Mahadi Bin Pg Haji DamitHiddenEquipment Deploy Details [Serial]HiddenSet 1 [Portable P.A System with Wireless Microphones] HiddenSet 2 [Portable P.A System with Wireless Microphones] HiddenSet 1 [Stand P.A System Speaker] HiddenSet 2 [Stand P.A System Speaker] HiddenSet 1 [Mondopad] HiddenSet 2 [Mondopad] HiddenSet 1 [TV] HiddenSet 2 [TV] HiddenSet 1 [Table Stand Microphone] HiddenSet 2 [Table Stand Microphone] HiddenSet 1 [Stand Microphone] HiddenSet 2 [Stand Microphone] HiddenSet 1 [Walkie-Talkie] HiddenSet 2 [Walkie-Talkie] HiddenSet 3 [Walkie-Talkie] HiddenSet 1 [Aver Video Camera] HiddenSet 2 [Aver Video Camera] HiddenSet 1 [Power Cable Extension 5m] HiddenSet 2 [Power Cable Extension 5m] HiddenSet 3 [Power Cable Extension 5m] HiddenRemarkHiddenOfficial Use [Return Details]HiddenReturning Date DD slash MM slash YYYY HiddenReceived By [TMC Staff]--select--Dr Hj Md Abul Fadle bin Hj Maidin / Hj MohiddinHaji Huzairi Bin Haji AjiDk Nazhatul Shahima Binti Pg HassanMohammad Ashadi Bin JamanMohammad bin Awang Haji KassimHaji Faritz Azirul Bin Haji RamlieHaji Mohd Nazmi Bin Haji AzahariMohammad Norhadi Bin Awang AhmadMohammad Arrafie Bin HassanSiti Amafina Binti Haji ZamanSiti Nursaaliah Binti AbdullahPg Shah Mahadi Bin Pg Haji DamitHiddenRemark
