Ref. No.

: IRC-ILL-IB ()

Interlibrary Loan / Document Supply Service Request

Name Program / Department

ID No. Email Address
Telephone No. Type of Degree
User Category Lecturer Executive Postgraduate Undergraduate (Final Year) (Please Tick ‘X’)
Type of Material Book / AV Journal / Proceeding Standard / Patent / Report (Please Tick ‘X’)

One request per form ONLY. Kindly fill in the details of the item you require in the appropriate section. Incomplete form will not be
processed. Request made by Postgraduate / Undergraduate Student (Final Year) must be verified by Supervisor. Email completed form
together with Supervisor’s verification email to ill_ircutp@petronas.com.my. All hardcopy resources are to be collected at the IRC
Circulation Counter, Level G.

ITEM: BOOK / AUDIO VISUAL

Title
Author
Publisher / Year
Edition
ISBN
University
Source of Reference

ITEM: JOURNAL / PROCEEDING

Article Title
Journal / Proceeding Title
Author
Year Page No.
Volume Part/Issue
Source of Reference

ITEM: STANDARD / PATENT / REPORT

Title
Author / Organization
Patent/Standard/Report No.
Volume
Publisher / Place / Year Page No.
Source of Reference

Have you searched in? FOR OFFICE USE ONLY

ULIBRARY Yes No Remarks:
IPTA / IPTS WEBOPAC Yes No Remarks: Received :
Recommended institution for ILL/DD Yes No Remarks: Process :
Supplier :

COPYRIGHT DECLARATION
By submitting this interlibrary loan/document delivery request, I agree to abide by all the following copyright restrictions. The copyright law of Malaysia
governs the making of photocopies or other reproductions of copyrighted material. Under certain specified conditions the photocopy or reproduction
is not to be “used for any other purpose other than private study, scholarship, or research. If a user makes a request for, or later uses, a photocopy
or reproduction for purposes in excess of “fair use”, that user may be liable for copyright infringement. This institution reserves the right to refuse to
accept a photocopy order, if, in its judgment, fulfillment of the order would involve a violation of copyright law.

I REQUEST A COPY OF THE WORK ON THIS FORM FOR PURPOSE OF PRIVATE STUDY, SCHOLARSHIP OR RESEARCH

Signature: ……………………………………….......... Date: …………………………………………………………….