Date:  _____________________

U-tel Guest application form
Applicant:

Passport #:

	Country:	First name:	Last name:	
Telephone #:	Date of Birth:	Gender: 
Male/Female
 	Position:

Partner’s passport #:	Partner’s name:	Arriving with Partner:                 Yes / No
	E-mail:

Host:

E-mail:

	Home #:

Office #: 
	Cell #:
	Department & Position:
	 Full Name:
	
Fax #:
	Emergency #. 
	Contact #.

	Position: 	Additional contact:

Requested accommodation period:  

From: _______________ to: _______________ Number of nights:___________

Payment Method:
•	Payment by the guest via: Credit Card / Mail payment voucher
(In case of non-payment by the guest, the payment will be charged to the budget number: 

__________________________).

•	Payment by the host from budget number:______________________

Host signature: _________________

Request validation:                                         Date:  _____________________

Your request for U-tel accommodation has been authorized, apartment No.____ floor___ 

Comments:
Please ensure that the guest has valid health insurance during his stay in the University.

Please inform us in writing in the case of any change / cancellation. Failure to advise on any change/cancellation will result in the charge being made. 

Mali Lahav 
Coordinator of Guest Apartments

For information on accommodations offered by the BGU refer to:
 http://in.bgu.ac.il/logistics/u-tel/Pages/default.aspx