Institute of St Marcellina
Residence
Hampstead Towers
 





 

Accommodation
Application

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print this page, complete form and send to:
The Institute of St. Marcellina
Hampstead Towers
6, Ellerdale Road
London, NW3 6BD
UK

(Please use BLOCK  letters)

 

Name in Full...................................................................................................

Date of Birth....................................................Place.....................................

Passport or ID No...........................................

Address..........................................................................................................

...........................................................................Tel.......................................

Length of stay: from..........................................To.......................................

Next of Kin.......................................................Tel......................................

References....................................................................................................

 

FOR  SAFETY  REASONS  SMOKING  IS  NOT ALLOWED

=====================================

 

Signature.......................................................................Date...................................

Please attach a passport-size photo.

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