NETWORK DIVISION
CENTRE FOR INTEGRATED INFORMATION SYSTEM
MARA UNIVERSITY OF TECHNOLOGY
40450 SHAH ALAM

Tel : 03-55442213/2180/2173/2174/2175 Faks : 03-55442197

APPLICATION FOR WIRELESS GUEST ACCOUNT

* Marks indicates compulsary field.

Applicant Detail:

Name*:

IC No* (without '-'):

Company*:

Email Address*:

Contact No:

Start Date (account)*


End Date (account)*
: Select A Date

: Select A Date



UiTM Staff Detail (for reference)

Staff Name*:

Unit / Centre / Faculty*:

Contact No*:

Email Address:

Signature & Stamping










Copyright © 2014 Unit Pengurusan Aplikasi Pejabat, Pusat Sistem Maklumat Bersepadu, UiTM Shah Alam. All Rights Reserved.