UNIVERSITI SAINS MALAYSIA - library.eng.usm.my

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No. Borang Q / Q-Form No.: ……..…………….. Tunai / Cash: RM……………….. Deposit / Deposit RM……….………. Diterima oleh / Received by: ...
PUSM/4/98

UNIVERSITI SAINS MALAYSIA PERPUSTAKAAN UNIVERSITI SAINS MALAYSIA UNIVERSITY SAINS MALAYSIA LIBRARY Rujukan: ………………….….

BORANG PINJAMAN ANTARA PERPUSTAKAAN (ARTIKEL) INTER-LIBRARY LOAN FORM (ARTICLE)

Ref.

Nama / Name: ……………………………………………………………….

No. Matrik / Matric No.: …………………..

Pusat Pengajian / Jabatan: ……………………………………………….

No. Telefon Bimbit: ………………………

School /Division

Handphone No.

E-mel / E-mail: ……………………………………………………………….

Tarikh / Date: …………………………….

MAKLUMAT BAHAN YANG DIMOHON / DETAILS OF ITEM REQUESTED Judul Jurnal / Journal Title: …………………………….……………………………………………………….…………. ………………………………………………………………………………………………………………………………….………..………………..

Judul Artikel / Article Title: …………………...…………………………………………………………………….………. …………………………………………………………………………………………………………………………..…..…..

Pengarang / Author: ……………………………………………..

No. Panggilan / Call no.:…………………….…....

Tahun / Year:

Volume / Volume:

No. / No.:

Bulan / Month:

Muka surat / Page no.:

………………

…………………..

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………………..

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Lokasi Bahan (sekiranya ketahui): Item Location (if known)

Perpustakaan Hamzah Sendut / Hamzah Sendut Library Perpustakaan Hamdan Tahir / Hamdan Tahir Library Perpustakaan Kampus Kejuruteraan / Engineering Campus Library Perpustakaan Institut Perubatan dan Pergigian Termaju (IPPT) / Advance Medical and Dental Institute (AMDI) Library British Library Document Supply Centre (BLDSC) Lain-lain sila nyatakan / Others please specify: …………………………………………………………………. (Dengan ini saya memperakukan bahawa permohonan ini untuk tujuan akademik sahaja) (I hereby declare that this request is for academic purposes only)

Tandatangan / Signature: ……………………………………..

UNTUK KEGUNAAN PEJABAT / FOR OFFICE USE ONLY Jenis Bayaran: Payment Type:

No. Borang Q / Q-Form No.: ……..……………..

Diterima oleh / Received by:………………………………..

Tunai / Cash: RM………………..

Deposit / Deposit RM……….……….

Tandatangan: ……………..

Tarikh/ Date:…………………..

Signature

Bahan diterima oleh / Item received by:……………………………………........................

Tarikh / Date:…………

Diproses oleh / Processed by:.………………………………………………………………..

Tarikh / Date:…………

Pemohon dimaklumkan oleh / Notified applicant by: …………………………..……………

Tarikh / Date:…………

Bahan diterima – Tandatangan pemohon: ………………………………..…………………

Tarikh / Date:…………

Item received – Applicant’s signature

Catatan: ……………………………………………………………………………………………………………………… Remarks ………………………………………………………………………………………………………………………………………………………………. Semakan2/0210

PUSM/4/98

Semakan2/0210