研究生宿舍遷離宿舍表.pdf
研究生宿舍遷離宿舍表.pdf
Ref: PGH-004/F/SRS 學生資源處 Student Resources Section (SRS) 研究生宿舍 - 遷離表 Postgraduate House (PGH) - Move-out Form * 此表格只作遷離研究生宿舍之用，若你是退學或休學，仍須到研究生院填寫辦理離校手續表格。 * This form is for moveout from the PGH only. If you withdraw from or suspend your studies, please also fill in the Student Check-out Form at the Graduate School. Ref No: __________/__________/__________ (1) 住客資料 / Resident Information 姓名 / Name:__________________________________________ 學生證號碼 / Student no.: ______________________________ 澳大職員號碼(如適用) / UM Staff no.(if any):________________ 流動電話號碼 / Mobile phone no: _______________________ 電郵地址 E-mail address: ____________________________________________________________________________________ 研究生宿舍 Postgraduate House: 南一座 S1 南二座 S2 南三座 S3 南四座 S4 西三十二座 W32 房間號碼 Room no.: ______________ 預期搬離日期/Expected move-out date：________(年/yyyy)_____(月/mm)_____(日/dd) 時間/Time_____________ 收集個人資料聲明 Personal Data Collection Statement ⚫ ⚫ ⚫ 澳門大學根據第1/2006號法律作為一所公立高等教育機構，將處理在本表格內所收集的個人資料作舉辦活動、提供服務及聯絡之用。The University of Macau being a public institution of higher education as set in Law No. 1/ 2006, will process the personal data collected on this form for activity organization, service providing and contact purposes. 基於活動 或服務所需，上述個人資料有可能轉交本澳相關機構。Due to the needs of the activity or service, the personal data on this form may be transferred to other organizations in Macao. 申請人有權依法申請查閱、更正或更新其存於本校的個人資料。The applicants have the right to access, rectify or update their personal data stored at UM. 住客簽名/Resident signature：______________________________ 日期/Date: _____________________________ --------------------------------------------------------------------------------------------------------------------------------------------------------------(2) 遷離宿舍時收取之費用及保證金安排 / Move-out anticipated fees payment and refund of security deposit arrangement Ref No: __________/__________/__________ 姓名 Name:____________________________________________ 學生證號碼 Student no.: ______________________________ 澳大職員號碼(如適用) UM Staff no.(if any):__________________ 流動電話號碼 Mobile phone no: _______________________ 電郵地址 E-mail address: ____________________________________________________________________________________ 第一部份 / Part 1 辦理遷離宿舍方法 / Method of Proceeding Move-out (請選選其中一項 / Please choose one option) □ 本人自行辦理遷離宿舍手續。 / I will process the move-out procedure by myself. □ 本人授權 / I authorize (學生證號 / Stud. No.) （姓名 / Name) _________________________ 辦理遷離宿舍手續 。/ to process the move-out procedure on my behalf. (Authorization letter attached) 第二部份 / Part 2 領取保證金方法 / Method of Collection of Security Deposit (請選選其中一項 / Please choose one option) (此部份只適用於畢業生、交流生、退學學生 Only applicable to for Graduate, Exchange, withdrawal of study students) □以現金方式自行取回保證金。/To receive the refund of security deposit by cash by myself. □扣除欠費後，保證金將會以自動轉賬方式退回至該已於學生資訊網登記之澳門銀行賬戶。/ After deduction of outstanding fee(s), security deposit will be refunded by auto-pay via the registered bank account(in Macao only) in SI Web. 收集個人資料聲明 Personal Data Collection Statement ⚫ ⚫ ⚫ 澳門大學根據第1/2006號法律作為一所公立高等教育機構，將處理在本表格內所收集的個人資料作舉辦活動、提供服務及聯絡之用。The University of Macau being a public institution of higher education as set in Law No. 1/ 2006, will process the personal data collected on this form for activity organization, service providing and contact purposes. 基於活動 或服務所需，上述個人資料有可能轉交本澳或外地相關機構。Due to the needs of the activity or service, the personal data on this form may be transferred to other organizations in or outside Macao. 申請人有權依法申請查閱、更正或更新其存於本校的個人資料。The applicants have the right to access, rectify or update their personal data stored at UM. 住客簽名/Resident signature：______________________________ Effective on 14/12/2021 日期/Date: _____________________________ Revision 006 Ref: PGH-004/F/SRS 學生資源處 Student Resources Section (SRS) 研究生宿舍 - 遷離表 Postgraduate House (PGH) - Move-out Form 學生資源處專用 / For Student Resources Section use only 1. 物品損壞/Article damaged 是/yes，MOP_______________ 否/no 2. 物品丟失/Article lost 是/yes，MOP_______________ 否/no 3. 垃圾處理費/Garbage removal fee 是/yes，MOP_______________ 否/no 4. 清潔費/Cleaning fee 是/yes，MOP_______________ 否/no 5. 其他費用 Other fees_________________ 是/yes，MOP_______________ 否/no 6. 電費應付單位/Electricity payable unit 7. 水費應付單位 Water payable unit 8. 未繳納之帳單 Unsettled Debit Note Notes: _________________ 單位/units，MOP_______________ _________________ 單位 units，MOP_______________ 是/yes，MOP_______________ 否/no 請注明 Please note: □ 本人同意繳交/從保證金中扣除以上費用(如有)。I agree to pay/ deduct from the security deposit for the above fees (if any). 住客簽名/Resident signature：______________________________ 實際遷離日期/Actualyl move-out on the date of _____________(年/yyyy)______(月/mm)______(日/dd) 已檢查房間 Checked the room 已歸還門卡 Returned the room card 處理人簽名/Handled by：____________________________ 日期/Date：_______________________________________ ----------------------------------------------------------------------------------------------------------------------------------------------------------------出納處專用 / For Treasury Section use only A. 保證金 / Security deposit: 1. 退還已預繳之保證金金額 / Refund security deposit which paid in advance: MOP B. 需繳交之費用 / Fees to be paid up on =-out: 1. 損壞物品費 / Article damaged fee 2. 丟失物品費 / Article lost fee 3. 垃圾處理費 / Garbage removal fee 4. 清潔費 / Cleaning fee 5. 電費 (房間號碼 ________) / Electricity fee (Room no ________) 6. 水費 / Water fee (房間號碼 ________) / Water fee (Room no ________) 7. 住宿費用 / Resident fees paid till (年 /yyyy) (月 /mm) 8. 其他費用(如適用，請注明） / Other fees (Please note, if applicable): MOP MOP MOP MOP MOP MOP MOP MOP 金額/Amount (日 /dd) C. 退還/補繳總金額 / Total amount of refund/ charge: MOP D. 保證金退回之確認(只適用於畢業生及交流生):Acknowledgement of security deposit refund (Graduate & Exchange students only): 本人/ 委託人 I / my consignor 已取回已預繳之保證金，金額為澳門幣/ have/ has received the refund of security deposit of MOP . 收款人/ Receiver : 日期/ Date : APPROVED BY DELEGATION Ref. No.: /FO-TRE / 20 BC No.: CC code: Prepared by: Amount: A/C code: Endorsed by: __________ /__________/__________ __________ /__________/__________ Ref No: __________/__________/__________ Effective on 14/12/2021 _____ _____ Approved by: _________ /_________/_________ Revision 006 Ref: PGH-004/F/SRS 學生資源處 Student Resources Section (SRS) 研究生宿舍 - 遷離表 Postgraduate House (PGH) - Move-out Form 出納處專用 / For Treasury Section use only 住客資料 / Resident Information 姓名 Name:____________________________________________ 學生證號碼 Student no.: ______________________________ 澳大職員號碼(如適用) UM Staff no.(if any):__________________ 流動電話號碼 Mobile phone no: _______________________ 電郵地址 E-mail address: ____________________________________________________________________________________ 研究生宿舍 Postgraduate House: 南一座 S1 南二座 S2 南三座 S3 南四座 S4 西三十二座 W32 房間號碼 Room no.: ________________________ 遷離日期/Move-out on the date of _____________(年/yyyy)______(月/mm)______(日/dd) E. 致學生資源處之確認收據： / Acknowledgement Receipt to be sent to Student Resources Section: (如住客已完成以下步驟，請將此確認收據交還給學生資源處/ Please send the acknowledgement receipt after the resident has completed the below procedures): 1. 已收妥學生之研究生宿舍 - 遷離表 / Postgraduate 是/yes 否/no 2. House (PGH) - Move-out form has been collected 住客已繳付所有有關研究生宿舍的欠款 / Resident has paid up all outstanding payments related to Postgraduate House (PGH) 是/yes，MOP_______________ 否/no 處理人簽名/ Handled by : Effective on 14/12/2021 日期/ Date : Revision 006