ACCOMMODATION REQUEST FORM - ENSIIE STUDENTS

Civility *
M.Mrs
Surname *

Name *

personal email *

VERY IMPORTANT: We will use this address to communicate essential information to you; You are solely responsible if you ignore them. Make sure you do not block receipt of our emails (spam filter). <\strong>

Date of birth *

format : dd/mm/yyyy
Nationality *

personal number phone *

Family Adress *

Family Postal Code *

Family Town*

Family Country*


CAUTION INFORMATION
Civility *
M.Mrs
Name *

Surname *

Adress *

Postal Code *

Town *

Country *

personal caution e-mail *

VERY IMPORTANTE : We will use this address to communicate essential information to you; you engage your sole responsibility if you ignore them. Make sure you do not block receipt of our emails (spam filter).<\strong><\label>
personal caution number phone *

INFORMATIONS ADHESION
Your school
ENSIIE



Your arrival date*

Aamong the opening days and hours of our offices :
Monday to Thursday from 1:30 p.m. to 5:30 p.m. - Friday from 1:30 p.m. to 4:30 p.m.

Attention ! This date cannot be modified, your first fee will be calculated from this date even if you arrive after
format : dd/mm/yyyy
Departure date :

"BANK DETAILS"

Country Code * (exemple : FR)

Country Controle Code* (exemple : France = 76)

Code BBAN * (exemple : establishment code + account + key)

Code BIC *: Insert the 11 characters of your BIC or SWIFT CODE (letters and/or numbers) if less than 11 characters, add XXX at the end to reach 11"

Titular account name

COMMITMENT

*In the event of inaccurate information, admission may be refused; Admission is only effective after signing your membership contract.
I certify on my honor the accuracy of the information communicated and to have read the Operating Charter of MAISEL SudParis.

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