Contoh 11 Borang Keahlian

KELAB PENCEGAHAN JENAYAH SMK (P) TRECHER METHODIST TPG NO.5 JALAN MUZIUM, 34000 TAIPING

LEKATKAN GAMBAR BERUKURAN PASPORT

PERAK DARUL RIDZUAN

MAKLUMAT AHLI :

NO. AHLI : .........................

Nama Ahli : ................................................................................................................................ (Nama Penuh Seperti Dalam K.P) No. Kad Pengenalan : ............................................................. Jantina : ................................... Tarikh Lahir : .................................................. Tempat Lahir : ................................................... Agama :........................................................... Bangsa : ........................................................... Alamat : ...................................................................................................................................... ....................................................................................................................................................

MAKLUMAT IBU BAPA / PENJAGA :

Nama Bapa : .............................................................................................................................. Pekerjaan : ...................................................... No. Kad Pengenalan : ..................................... No Telefon : (R) : ....................................................... (P) : ........................................................ (HP) : ......................................................

Nama Ibu : .............................................................................................................................. Pekerjaan : ...................................................... No. Kad Pengenalan : ..................................... No Telefon : (R) : ....................................................... (P) : ........................................................ (HP) : ......................................................

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Nama Penjaga : ......................................................................................................................... Pekerjaan : ...................................................... No. Kad Pengenalan : ..................................... No Telefon : (R) : ....................................................... (P) : ........................................................ (HP) : ......................................................

PERAKUAN AHLI :

Saya ..................................................................................................(Nama seperti dalam KP) Tingkatan / Tahun ...................................................................................................................... berjanji akan menjadi ahli yang sentiasa mematuhi peraturan dan perlembagaan kelab, peraturan sekolah dan sentiasa menjaga nama baik kelab dan sekolah di samping mencuba sedaya upaya mengharumkan serta memartabatkan nama baik kelab dan sekolah ini.

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(Tandatangan Ahli)

(Tarikh)

( NAMA AHLI :

)

Disediakan oleh,

.................................................................

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(KAMIRUN BIN MUSTAPA KAMAL)

(Tarikh)

Ketua Guru Penasihat, Kelab Pencegahan Jenayah (KPJ) SMK (P) Treacher Methodist Taiping

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