Student Dormitory Property Loss Waiver Form
Student Information
Full Name
Student ID
Room Number
Contact Number
Incident Details
Date of Incident
Description of Lost Property/Incident
Estimated Value
Waiver & Declaration
I hereby waive any claim against the student dormitory for the above described property loss, and declare that the information provided is true and complete to the best of my knowledge.
Student Signature
Date:
Dormitory Staff Signature
Date: