ETR 300 ENTREPRENEURSHIP "BUSINESS PLAN"

FRESH CHICKEN FARM

NAME OF PARTNERS: 1. 2. 3. 4. MOHAMAD SHUKRY B. MAKSAH MUHAMMAD FAIRUZ B. JOHARI MUHD. NURFAIZ B. BAHARUDDIN AHMAD LUQMAN B. MOHAMED SHAIHANI 2003230540 2003231714 2003231634 2003230883

Prepared For: EN MALIKI B IBRAHIM (FKE) EN HUSNY B BASIR (MEDEC)

DIPLOMA IN ELECTRICAL AND ELECTRONIC ENGINEERING

FACULTY OF ELECTRICAL ENGINEERING

DATE OF SUBMISSION 13 OCTOBER 2005

TABLE OF CONTENTS COVER LETTER ACKNOWLEDGEMENTS AGREEMENT OF BUSINESS ORGANIZATION LOGO INTRODUCTION 1.1 EXECUTIVE SUMMARY 1.2 BUSINESS PLAN PURPOSE 1.3 BACKGROUND OF OWNERS 1.4 PARTNER'S PROFILE ADMINISTRATION PLAN 2.0 INTRODUCTION TO THE ORGANIZATION i. ii. iii. iv. v. VISION OBJECTIVE BUSINESS ADDRESS LOCATION PLAN TYPES OF BUILDING AND INFRASTRUCTURE

PAGE

1-m

iv v-vii 1

3 4 5 6-9

10

1 1 12 13 14 15 16 17

a) OFFICE LAYOUT 2.1 ORGANIZATION CHART OF FRESH CHICKEN FARM 2.2 LIST OF ADMINISTRATION PERSONNELS 2.3 SCHEDULE OF TASK AND RESPONSIBLITIES 2.4 SCHEDULE OF REMUNERATION 2.5 LIST OF OFFICE EQUIPMENTS AND SUPPLIES 2.6 ADMINISTRATION BUDGET OF FRESH CHICKEN FARM

18-20
20 21 22

MARKETING PLAN 3.0 INTRODUCTION 3.1 PRODUCT OR SERVICE DESCRIPTION 3.2 TARGET MARKET 3.3 MARKET SIZE 3.4 MAIN COMPETITORS /. ii. iii. STRENGTHS OF COMPETITORS WEAKNESSS OF COMPETITORS STRENGTHS OF FRESH CHICKEN FARM

23 24 25 26 27

3.5 MARKET SHARE 3.6 SALES FORECAST 3.7 MARKETING STRATEGIES i. ii. iii. iv. PPRODUCT PRICING PLACE/DISTRIBUTION PROMOTIONS

28 29 - 30 31

32 33 34 35 36 37 38 39 40 41 42 43

3.8 MARKETING BUDGET OPERATION PLAN 4.0 INTRODUCTION 4.1 FLOW CHART OF OPERATION ACTIVITIES i. ii. i. ii. FLOW CHART CONVENTIONAL SYMBOLS PROCESS FLOW CHART READY OF BOILER CLOSED HOUSE INSTALL THE NECESSARY BROODING EQUIPMENT a. DRINKER SYSTEM b. FEEDING SYSTEM c. PAD COOLING SYSTEM

4.2 OPERATIONS SYSTEM

iii. iv. v.

CHICK PLACEMENT CHICK QUALITY DAILY CONTROL AND QUALITY CONTROL a. VENTILATION b. FEED AND WATER c. LIGHT d. DISEASE CONTROL e. BIO-SECURITY

44

45 46 47

vi.

GROWING PHASE a. UNIFORMITY b. MODIFICATION OF FEED AND NUTRIENT INTAKE c. LIGHTING PROGRAMS

48

49 50 51 52 53 54 55-57

vii. viii.

CATCHING PROCESS DISINFECTION

4.3 BUSINESS OPERATION TIME 4.4 CAPACITY PLANNING 4.5 TOTAL COST 4.6 MATERIAL REQUIREMENTS (INPUT) 4.7 LIST OF OPERATIONS PERSONNEL 4.8 SCHEDULE OF TASKS AND RESPONSIBILITIES 4.9 SCHEDULE OF REMUNERATION 4.10 MACHINE AND EQUIPMENT i. ii. INFRASTRUCTURE DEVELOPMENT EQUIPMENT AND MACHINERY 58 59 60

4.11 OPERATIONS SPACE LAYOUT PLAN 4.12 OPERATION OVERHEAD 4.13 OPERATION BUDGET

FINANCIAL PLAN 5.0 INTRODUCTION i. OBJECTIVE 5.1 PROJECT IMPLEMENTATION COST SCHEDULE 5.2 SOURCE OF FINANCE SCHEDULE 5.3 SUPPORTING SCHEDULES i. ii. i. ii. iii. LOAN OF AMORTIZATION SCHEDULE FIXED ASSET DEPRECIATION SCHEDULE CASH FLOW PROFORMA (ANUALLY) PROFORMA PROFIT AND LOSS ACCOUNT FRESH CHICKEN FARM PROFORMA BALANCE SHEET ACCOUNT FRESH CHICKEN FARM CONCLUSION / RECOMMENDATIONS APPENDIXES

61 62 63 64 65 66 67 - 71 72 - 73 74 75

5.4 PROFORMA FINANCIAL STATEMENTS

76 - 77 78

Diploma In Electrical and Electronic Engineering, Faculty of Electrical Engineering, Mara University of Technology, Shah Alam Campus, 40450 Shah Alam, Selangor.

En. Husny B. Basir Lecturer of Fundamentals of Entrepreneurship (ETR 300) MEDEC,Blok 13 Intekma Resort & Convention Centre (Level 4) 40450 Shah Alam Selangor Darul Ehsan Dear Sir, Submission Of Business Plan Referring to the matter above, Fresh Chicken Farm would like to submit the business plan for your analysis and references. Fresh Chicken Farm would start our business with partner and address mentioned below:Details of partners are as follows:1. Mohamad Shukry B. Maksah 2. Muhammad Fairuz B. Johari 3. Muhd. Nurfaiz B. Baharuddin 4. Ahmad Luqman B. Mohamed Shaihani 2003230540 2003231714 2003231634 2003230883

Business address:-

FRESH CHICKEN FARM Lot 3307, Batu 7, Lorong Sarkawi, Jalan Kebun 42 450 Klang, Selangor Darul Ehsan

We have tried our best to prepare this business plan with all data compiles for your good judgments. This working paper is a group effort and all experiences gained are valuable lesson for entire group members.

We hope that our business plan will satisfy your requirement for this subject (ETR 300). We also hope that our business plan can give some benefit to other people especially as a reference material for the future.

Yours sincerely,

(Mohamad Shukry B. Maksah) General Manager

(Muhd. Nurfaiz B. Baharuddin) Marketing Manager

lammad Fairuz B. Johari) Operation Manager

(Ahmad Luqman B. Mohamed Shaihani) Financial Manager

in

ACKNOWLEDGEMENT
We would like to thank ALLAH S.W.T for His blessings that we were able to finish this assignment. We would also like to thank our lecturers, En Maliki and En Husny for the guidance and lectures that have given us a clear view on how to document our business plan.

In preparing the plan, we have also come across several individuals and interviewed them for information gathering. We would like to extend our gratitude to them particularly En Baharen and En Azaruddin because of their willingness to spend their time in answering our questions regarding chicken business.

Last but not least, we would also like to thank our classmates who have helped us in answering questions related to the business plan. Their generosity and assistance are greatly appreciated.

IV

AGREEMENT OF BUSINESS

The agreement letter has been made on 28 July 2005 between 4 partners of the company and below is the list of partners and the agreed terms.

Mohamad Shukry B. Maksah 850628-10-5221 41 Jin Sri Damak 50, Taman Sri Andalas, 41200 Klang, Selangor.

Muhd. Nurfaiz B. Baharuddin 850720-14-5883 167 Jin. Tun Abdul Razak, Taman Sri Andalas, 41200 Klang, Selangor.

Muhammad Fairuz Bin Johari 851107-07-5455 99 Jin. Sri Damak 22, Taman Sri Andalas, 41200 Klang, Selangor.

Ahmad Luqman B. Mohamed Shaihani 850515-10-5559 11 Jin. SriSedeli5, Taman Sri Andalas, 41200 Klang Selangor.

Partners of Fresh Chicken Farm have agreed to all the terms and conditions that have been discussed and all the terms and conditions of the company are stated as below: 1. The partners have agreed with the name of the company Fresh Chicken Farm and all businesses with the company should apply the mailing address as below: FRESH CHICKEN FARM Lot 3307, Batu 7, Lorong Sarkawi, Jalan Kebun 42450 Klang, Selangor Darul Ehsan 2. All partners agree with the reasonable salaries given to them. 3. Documents such as profit and loss statement, balance sheet and other confidential documents shall not be revealed to others. 4. Every partner is entitled to participate in the management of the business. 5. Every partner knows of the risk and agrees that the liability for the company is unlimited and we are ready to pay off all liabilities for the company with own properties.

VI

Below are the signatures of all partners that have agreed with all the terms given above.

MOHAMAD SHUKRY B. MAKSAH I/C: 850628-10-5221

MUHAMMAD FAIRUZ B. FOHARI I/C: 851107-07-5455

MUHD. NURFAIZ B. BAHARUDDIN I/C: 850720-14-5883

AHMAD LUQMAN B. MOHAMED SHAIHANI I/C: 850515-10-5559

Vll

FRESH CHICKEN FARM

DEFINITION OF THE LOGO

FRESH CHICKEN FARM

| z ) Represent the name of our company.

CIRCLE SHAPE

l~~> Represents unity between partners and all the employees.

WHITE BIRDS

Represent our products

BLUE

Hy Represent the courage and hard work among the

partners and employees.

1.1 EXECUTIVES SUMMARY This business is based on partnership where it consists of four (4) members. The members consist of the General Manager, Administration Manager, Marketing Manager, Operational Manager and Financial Manager. The business capital is amounted to RM372,410 where the total contribution of each member is RM79,910 and the rest is from the Bank Pertanian loan.

FRESH CHICKEN FARM is a company related to the breeding the chicken meat. Our market focus is for the Pertanian Pertiwi, a company that directly deals with us, they will supply the day-old-chicks with the certain price and buy the chicken back when it reach at certain age (normally at 50 days). For those who are interested to buy the fresh chickens, we can't sell to them due to our contract with the Pertanian Pertiwi. Our business will be expected to commence on 2006 and our vision is to make our company a well-known, established and satisfied by our customer in order to expand our capacity of chickens and to attract other companies to deal with us with a better price. This will be realized by the full cooperation and efforts among the partners to promote this company. Based on the objectives above, we are venturing into livestock industry. Chickens' farming has the potential of being a profitable business if it's done in modern way with large scale and systematically managed. We will expect that our business will become more developed in the near future because the demand for the chicken's meat is high and not many breeders use the closed system. This will give more advantages for us to make our product more profitable and stabile in the long run.

1.2

BUSINESS PLAN PURPOSE

The main purpose of this business plan is for the reference of several audiences / parties such as:

1. The Entrepreneurs (Fresh Chicken Farm's managers). To better understand the purpose of the business and act as guideline to manage the business effectively and efficiently.

2. Financial Institutions. Assist and help the financial institution to evaluate the capability of the proposed project and provide loan for the business. Financial institution involved in this business project is Bank Pertanian Malaysia.

3. Suppliers. Help convince suppliers of the viability of our business venture thus benefiting both the suppliers and our company in the long term business arrangement.

4. Company Staffs / Workers. Help workers to understand the business's goals and objectives and give a guideline to them regarding their job duties and responsibilities.

5. Customers. Persuade and influence our customers regarding the products being offered and gives assurance and confidence to them to have business with us.

13

BUSINESS BACKGROUND

Below is the business background for our company:Name of Business/Company : FRESH CHICKEN FARM Address : Lot 3307, Batu 7, Lorong Sarkawi, Jalan Kebun, 42450 Klang, Selangor Darul Ehsan. Telephone Fax No. Form of Business Main Activities Date of Registration Number of Registration Date of Commencement Initial Capital Name of Bank Account No. : 03-31222372 : 03-31222375 : Partnership : Providing services of breeding the chicken meat. : In progress : hi progress : hi progress : RM 79,910 : Bank Pertanian Malaysia

: 40950003456

1.4

PARTNER'S PROFILE

1.

Name Identity Card Number Permanent Address

Mohamad Shukry B. Maksah : 850628-10-5221 : 41 Jin. Sri Damak 50, Taman Sri Andalas, 41200 Klang, Selangor.

Telephone No. Date of Birth Age Marital Status Academic Qualification Courses Attended Skills Experience Present Occupation Previous Business Experiences

: 019-3079070 :28 th June 1985 : 20 years old : Single : Diploma In Electrical Engineering : Entrepreneurship : Computer related :None : Undergraduate :None : None

2.

Name Identity Card Number Permanent Address

Muhammad Fairuz B. Johari : 851107-07-5455 : 99 Jin. Sri Damak 22, Taman Sri Andalas, 41200 Klang, Selangor.

Telephone No. Date of Birth Age Marital Status Academic Qualification Courses Attended Skills Experiences Present Occupation Previous Business Experiences

: 017-3082892 :7 t h November 1985 : 20 years old : Single : Diploma In Electrical Engineering : Entrepreneurship :None : None : Undergraduate : None : None

3.

Name Identity Card Number Permanent Address

Muhd. Nurfaiz B. Baharuddin : 850720-14-5883 : 167, Jalan Tun Abdul Razak, Taman Sri Andalas, 41200 Klang, Selangor.

Telephone No. Date of Birth Age Marital Status Academic Qualification Courses Attended Skills Experiences Present Occupation Previous Business Experiences

: 012-6045320 : 20th July 1985 : 20 years old : Single : Diploma In Electrical Engineering : Entrepreneurship : None. : None. : Undergraduate : None :None

4.

Name Identity Card Number Permanent Address

: Ahmad Luqman B. Mohamed Shaihani : 850515-10-5559 : 11 Jin. Sri Sedeli 5, Taman Sri Andalas, 41200 Klang, Selangor.

Telephone No Date of Birth Age Marital Status Academic Qualification Courses Attended Skills Experiences Present Occupation Previous Business Experiences

: 012-9157455 : 15th May 1985 : 20 years old : Single : Diploma In Electrical Engineering : Entrepreneurship : None : None : Undergraduate : None :None

Fl

yj J

7J

10

2.0 INTRODUCTION TO THE ORGANIZATION

Administration plan is first step of business to become more developed and expounded in the future. It is important in every business. The effectiveness of FRESH CHICKEN FARM is based on the administration that has been planned systematically and followed by the proper planning before the business is established. The important things that have been taken care of are well organization and effectiveness in administration plan. Several things that are included in this part are; > Organization planning > Organization chart > Numbers of workers/labor > Administration budget > Office layout > Remuneration Table > Workers intensive ^ Position, responsibilities and specific task

Vision It is FRESH CHICKEN FARM to be strength and famous farm over the world as a quality and fresh "chicken" provider in order to fulfill an increase of market demand for this favorite chicken by the year 2015. FRESH CHICKEN FARM should be promoted to other countries to our vision that our local favorite chicken is to meet a satisfying among foreigners.

11

Objective 1) Justly to compensate the employees and owners of FRESH CHICKEN FARM. 2) Contribute to the development and growth of the country's economy and to increase the percentage of Bumiputera involves in business 3) To create productivity among employees 4) To provide the best quality of "chicken" every time in order to attract more customers

Business Address Our business will be situated at the following address: FRESH CHICKEN FARM Lot 3307, Batu 7, Lorong Sarkawi, Jalan Kebun 42 450 Klang, Selangor Darul Ehsan

12

b) Location Plan

LORONGAKTBAKSR"
MARDI HOUSE AREA

FRESH CHICKEN FARM

JAUWKH

-mrnmm
PUUWMDAH

FROM KUA1A LUMPUR

KESAS HIGHWAY
ECONSAVE HOUSE AREA PROTON SERVICE CENTER ESSO

TESCO

BUWTTWGGJ (AMPIINGJA^I
TEMPLE Shell GIANT

FROM HAH ALAM

Hospital Besar Klang

KLANG

13

Type of Building and Infrastructure Among the facilities that are provided at our project site are: 1. Office 2. Toilet

We have chosen a project site which has all the necessary facilities and infrastructure as a catalyst for the growth and development of our business, FRESH CHICKEN FARM. Our business is situated only 45 minutes away from Kuala Lumpur through KESAS highway.

Among the many infrastructures that can be found in the project site are: a) An excellent highway system where it can facilitate the customers to frequent the project site and buy our products. It will also make it more convenient for the suppliers to come and supply the raw materials needed by our company.

b) Electricity power supply has already been provided by the Tenaga Nasional Berhad along the Jalan Kebun.

c) Telephone line has already been made available by the Telekom Malaysia Berhad and also water supply from the Water Department along Jalan Kebun.

14

OFFICE LAYOUT

< )

1 ** -

i**

FINANCIAL MANAGER

OPERATION MANAGER

MARKETING MANAGER

)GENERAL MANAGER

D
tF^

a
Telephone

KEYS:

Chair

Sofa

Computer Board

Toilet

White

Table

15

2.1 ORGANIZATION CHART OF FRESH CHICKEN FARM

GENERAL MANAGER

ADMINISTRATION MANAGER

MARKETING MANAGER

OPERATION MANAGER

FINANCIAL MANAGER

WORKERS

WORKERS

The style of the organization chart is designed on functional style. The organization structure on functional style is very effective to the any company which are need peculiar specialize.

16

2.2 LIST OF ADMINISTRATION PERSONNELS

SERIES 1 2 3 4

POSITION General Manager Operation Manager Administration Manager Marketing Manager Financial Manager Trained Workers TOTAL

NO OF PERSONAL 1 1 1 1 1 2 7

5
6

17

2.3 SCHEDULE OF TASK AND RESPONSIBLITIES

POSITION

TASKS AND RESPONSIBILITIES

Making connection and establishing contact with the main supplier, PERTANIAN

PERTIWI SDN BHD. Form the business policies and guidelines Making decisions and solve all problems faced by Fresh Chicken Farm. Help the Marketing Manager to promote the chicken products.

General Manager

Find out more information and do research about setting up and operating a chicken's farm successfully.

Choose quality livestock from the supplier, PERTANIAN PERTIWI SDN BHD.

Responsible and liable for all business risks or any problems regarding business or workers

To forecast sales and income To administrate the business structure Lay out all plans and ensure that all things are done according to plans

Determine the wages and salaries received by workers and contribute the percentage of the salaries to EPF and SOCSO.

Make the decisions regarding administrative tasks and office works.

Responsible for all mails and correspondences connected with the business.

To assist general manager in the business To involve in guiding a new worker in case of a new recruitment

Administration Manager

Help to achieve the business target by implementing business ideas and strategies

18

Find other strategies to help increase sales Analyze the strengths and weaknesses of competitors.

Handle

the

advertisement,

banners

and

Marketing Manager

signboard placement. Make sure the customer receive good service. Able to interact and try to make the customers to have confidence in our business To analyze the opportunity in the economy, choose and grab the opportunity based on the business

Find and place a suitable pricing for every chicken product sold.

Deal in the buying of food for the chicken Responsible for the training of new workers and monitor the job quality of all operation workers.

Operations Manager

Monitor th health of chickens. To make sure that all stocks are in good condition

To make sure all the stocks are enough to meet the demand

Informing suppliers when there are extra orders needed

Prepare the company financial report Keep all the financial records and business accounts in the safety place.

Record and monitor all the income received and expenses incurred by the business.

Responsible for controlling and managing company's financial capital and cash flow.

Financial Manager

19

Advice the manager regarding the financial matters.

Make a budget of business example financial statement, profit, and loss account, and balance sheet

Search for the information of capital and asset activities.

2.4 SCHEDULE OF REMUNERATION

NO OF DESIGNATION EMPLOYEE

MONTHLY SALARY (RM)

EPF (12%) (RM) 204.00 156.00 156.00 156.00 156.00 120.00 948.00

socso
(2.5%) (RM) 43.00 33.00 33.00 33.00 33.00 25.00 200.00

TOTAL

(RM) 1,947.00 1,489.00 1,489.00 1,489.00 1,489.00 1145.00 9,048.00

General Manager Operation Manager Admin Manager Marketing Manager Financial Manager Trained Workers TOTAL

1 1 1 1 1 2 7

1,700.00 1,300.00 1,300.00 1,300.00 1,300.00 1,000.00 7,900.00

20

2.5 LIST OF OFFICE EQUIPMENTS AND SUPPLIES

NO

TYPE

QUANTITY

PRICE/UNIT (RM)

TOTAL (RM)

1.

OFFICE EQUIPMENTS

a. COMPUTER (PARTNERS CONTRIBUTION) b. AIR CONDITIONER c. TELEPHONE & FAX MACHINE d. FIRST AID e. WHITE BOARD f. CABINET/FILE FOLDERS

2,500

1 1

1,180 1,000

1,180 1,000

1 1 4

100 120 400

100 120 1,600 170

g. ADDITIONAL ACCESSORIES

TOTAL 2.

6,670

FURNITURES

a. CHAIRS b. SOFA c. TABLE

8 1 SET 4

60 1,100 150

480 1,100 600

TOTAL

2,180

21

2.7 ADMINISTRATION BUDGET OF FRESH CHICKEN FARM

TYPE

Fixed Asset Cost (RM)

Monthly Expenses (RM)

Yearly Expenses (RM)

Fixed Asset: Land &Building Furniture Office equipments Renovation 138,000 2,180 6,670 -

Monthly Expenses: Salary, EPF, SOCSO Stationary Miscellaneous Telephone bill 6,414 50 100 500 76,968 600 1,200 6,000

Other Expenses: Registration & Licenses Deposit Insurance & Road Tax Other Expenses 100 1,200 -

22

23

3.0 INTRODUCTION

Marketing is a social and managerial process by which individuals and group obtain what they need and wants through creating and exchanging products and value with others. It can be defined as an activity that are carried out systematically to encourage and increase sales of products or services as long as the activities are in the line with religious and ethical practices. Marketing is basically an exchange activity that takes place between a business entity and its customers. The customers can conclude individuals, others business entities (e.g. wholesalers and retailers) and support organizations (e.g. banks and government agencies). Marketing is a critical activity in any business because it forms the backbone to the total business effort in achieving a profitable outcome. Consequently, the challenge in any business is to produce and offer a product that results in profit for the business and, more importantly, satisfies the target customer. r 3.1 PRODUCT OR SERVICE DESCRIPTION

Our business will be name as 'FRESH CHICKEN FARM'... holding one marketing concept where our operation, strategy and manufacturing are done regarding customer's needs and wants. In the other words, the customer satisfy is a major concerning in every effort and strategy to ensure that our business can be compete and more longer in market. We have chosen a business that deal with the distributor, whereby they are an agreement that the distributor will supplies the chick to us, then we will breed its until a certain level before the chicken return back to them. There are only 18,000 chicks per batch that we will take. It takes a year the contract of this business.

24

3.2 TARGET MARKET

The target market is defined as the groups of customers that have needs and wants that can be satisfied by the business through the supply of goods and services. It's important for us to have a target market to determine our customers needs and wants towards chicken. Since that our business has a contract with other company, which is our distributor, therefore, our target market is 'Pertanian Pertiwi Sdn Bhd'(distributor). Our company does not have a specific area or outlet to distribute our product because we have a deal with the distributor. In the agreement, it states that we will get the supplies (chicks) from the distributor and after a certain level, we will sell it back to the distributor.

3.3 MARKET SIZE

Market size refers to the total potential purchase of the target market. Since we have a contract, so the market size is depend on the purchasing of our distributor. According to our distributor, we had been informed that their annual sale is RM15,779,840. Therefore this is our market size. The table below shows the target market of their company.

OUTLET

EXPECTED PURCHASE Per year (RM)

PERCENTAGE (%) 35 20 30 10 5 100

Wet Market Hotel Restaurant Factory / School Canteen Individuals TOTAL

5,52,944 3,155,968 4,733,952 1,577,984 788,992 15,779,840

25

3.4 MAIN COMPETITORS

In our business operating, there are many competitors that operate a same business like us. Competitors actually refer to other businesses that offer similar, substitute or an alternative products or services to the same target market. We have to analyze the strengths and weaknesses of our competitors in term of size, experience, and years in business, financial ability and product line in order to compete together with them. Here we have identify some entrepreneurial that operate chicken business located in the same area: Hj. Kamaruddin b Hj. Ellyas Kim Too Siong En Baharen M.Daie.

All the above competitors have been long in this business before we entered the business. Therefore, most probably they have established themselves and have more experience in facing towards customers. What can we do is trying to have a good business and make the competitors as our activator to succeed in the business.

26

STRENGTHS OF COMPETITORS > They have been in the business for a long time before us and make them already have permanent customer. > They have a large source of capital to expand their market. > They have more experience in operating the business compared to us. Customers know them well and more confident to work with them.

WEAKNESSS OF COMPETITORS ^ Their operation management is not systematically. ^ The price of the chicken is not suitable with the quality of the product selling. > Their farm is 'open system', produce low quality product. > Less promotion to spread widely their business.

STRENGTHS OF FRESH CHICKEN FARM

^ Our operating is more systematic to ensure that our chickens are grower in better condition. > Our price is suitable with the size of chicken selling. > We care of the quality of the chicken selling to buyer. > Applied high technology on the farm. (Close system) > We have well in promotion and ensure a good relationship with our distributor. * Nevertheless, we have our weakness that we are still new in our business and have less experience compared to other competitor.

27

3.5 MARKET SHARE

Market share refers to the estimated potential sales of the business after taking into consideration of the market size and competitors influences. Based on our market size, RM 15,779,840 we can estimate our 5% share of market. The table below shows the market share before and after 'FRESH CHICKEN FARM' entered market.

Name of

Before % Amount (RM) 25 3,944,960 share

After % (RM) 25 3,944,960 Amount

Company Hj. Kamrauddin b. Hj. Ellyas Kim Too Siong

share

20

3,155,968

20

3,155,968

En Baharen M.Daie

15

2,366,976

15

2,366,976

Others

40

6,311,936

35

5,522,944

'FRESH CHICKEN FARM' TOTAL 100 15,779,840

788,992

100

15,779,840

28

3.6 SALES FORECAST Sales forecast is expected purchases from the identified target market. There will be an increase in our sales every year for our three years forecast seems that the high demand for chicken in the market. There is a possibility that the customers needs a better quality of chicken and choose us as their new supplier. The following table shows the forecasted sell for the first three years. Sales Forecast for year 2006,2007 and 2008 (RM) MONTH NO OF UNIT (kg) January - February March - April May - June July - August September - October November - December Total-2006 Total-2007 Total - 2008 41,055 41,055 41,055 41,055 41,170 41,170 246,500 246,500 246,500 SELLING PRIZE (RM/kg) 3.20 3.20 3.20 3.20 3.20 3.20 3.20 3.20 3.30 AMOUNT (RM) 131,376 131,376 131,376 131,376 131,744 131,744 788,992 788,992 813,450

In our business, we have a certain period of time to produce our product. Operation of our product will take about two month before it's will be market. Therefore, we just can make a forecast per batch, which means every two-month we will gain in sales. We start our project in January and get 18,000 of chick from the distributor. From the table above, our product that we sell to the distributor is 41,055, which is 17,850 of chicken with average weight 2.3kg in the first, second, and third batch (JanAug). We expect that 150 chicken will died. On the forth and fifth batch, there are only 100 died. To achieve this target, we will make sure that our operation was good. The distributor also will help us by giving an extra 200 of chicks in every batch. On 29

September to December, they will give us extra 250 of chicks because of the festival season. From the graph below, it shows that our selling forecast in year 2006, 2007 and 2008. In the agreement, the price for a chicken is fixed, RM3.20/kg. The graph shows that the pattern of selling in year 2006 and 2007 is same and in 2008, it will increase 3% by increasing our selling price to RM3.3O/kg while we renew our agreement with the distributor.

Graph On Sales Forecast

136,000 135,000 134,000 Amount (kg)

133000

n
_ _

132,000 131,000 130,000 129,000

n rr r

i
1

D Year 2006 Year 2007 Year 2008

1 .,

Month

30

3.7 MARKETING STRATEGIES Our business operating is supplying the meat chicken. In this business, we are dealing with other company as a distributor which they as an agent to distributed our product. We supply the chicken and they processed the chicken for selling to the customer. Therefore, our marketing strategy is to make the distributor more confident towards our quality of product. In order to achieve our target, we have developed appropriate marketing strategies to generate the sales from the target market. There are four factors to be considered which are as follows; a) Product b) Price c) Place (distribution) d) Promotion

a) Product Our farm provides a good quality of chickens, which are from a good heredity (grade A) and free from infectious disease. We will operate our farm carefully to ensure that it's always been satisfy by our distributor. In this business, the distributor will give a guideline for us to control our quality of products. To achieve the standard level of our product, we will make sure that our operation will operate according to the guideline given. Besides, the distributor will come to our farm every two weeks to make sure that our chickens have a good health. Our business provides a clean environment of a farm, which is very important for giving a view to our quality product. A good quality of chicken also comes from their good quality of feed.

b) Pricing The price of chicken is fixed based on our agreement with the distributor. Otherwise, in order to put a price for our product, we are using 'competition-based pricing' concept and make a comparison regarding quality and

31

size of the chicken. The proper price fixed by our business is RM3.20/kg where usually the price fixed by competitors is RM3.50/kg.

c) Place/Distribution We have chosen Jalan Kebun at Klang as our project site based on some factor; Farm is far away from town and housing area Farm have access to transportation and be able to operate all the time Land are flat and have good drainage The area is well ventilated

Seems that our location is in Klang , its will encourage the distributor to make a deal with us. d) Promotion An impressive promotion is needed to ensure that our missions are achieved. A step of promotion should be taken in order to achieve our vision to make everyone known our potential and get a chicken supply from our company. Promotions are based on; Signboard It's very important for each business to have a signboard to introduce the business and let everyone know the location of the project site. Our business will have two signboards that will be put in front of our office and the side of road that mention the way to our farm. Business card Our business card will be given especially to our vendors who visit our farm. It's make people know how to contact us as a manager to make a business or directly come to our farm based on address given.

32

Website We will make a business website for our company seems that Internet is the most important communication tool among the communities nowadays. All information regarding our business will be advertised in the homepage MOHAMMAD SHUKEY B. MAKSAH (General Manager) Lot 3307, Batu 7, Lorong S&rkawi, Jalart Kebun, 42450 Klang, Tel:03-31222372 H/p : 019-3079070 www. f reshchickenfa rm. com

Fresh GbkkenFarm

MUHD NURFAIZ B. BAHARUDDIN (Marketing Manager) Lot 3307, Batu 7, Lorong Sarkawi, Jalan Kebun, 42450 Klang, Tel:03-31222372 H/p : 012-6045320 www. f reshchickenfa rm.com

Fresh Chicken F&rtn

MUHAMMAD FAIRUZ B JOHARI (Operation Manager) Lot 3307, Batu 7, Lorong Sarkawi, Jalan Elebun, 42450 Klang, Tel: 03-31222372 H/p : 017-3082892 www. f reshchickenfa rm. com

Fresh hickn Farm

33

AHMAD LUQMAN B. MOHAMMED SHAIHANI

(Financial Manager) Lot 3307, Batu 7, Loiong Sarkawi, Jalan Kebun, 42450 Klang, Tel: 03-31222372 H/p : 012-9157455 www. freshchickenfa rm. com

Fresh

3.8 MARKETING BUDGET

Remuneration Table Monthly POSITION MONTHLY SALARY (RM) EPF 12% (RM) Marketing Manager 1300 156

socso
2.5% (RM) 33

TOTAL (RM) 1489

List Of Marketing Budget Type Fixed Asset Cost (RM) Fixed Asset Signboard
Working Capital

Monthly Expenses

Other Expenses (RM)

(RM)

500

Salary, EPF, SOCSO Miscellaneous

Other Expenses

200 100

Business Card

34

35

4.0 INTRODUCTION

Operation Management Operation management can be defined as the process of marshalling resources to produce output through the transformation process. The operation process comprises three main components, i.e. business input, transformation system and output. Business input refers to all resources required to produce a particular output. Examples of input are manpower, raw materials, machines and equipment, technology, information and capital. The transformation system refers to the activities involved in transforming input into output. Among others, the processing system involves planning of raw materials, designing of operational process, planning of floor layout and distributing of manpower in the organization. Output refers to the end product created as the result of the transformation process. Business output can be categorized into either products or services. As input is transformed into output, it acquires added value, whereby the value of the output is higher than the total input value. Our purpose focus in operational plan is to breed and to ensure chicken that we supply is high quality to fulfill our customer needs and wants. With the quality, exact time and place we planned at the lowest cost but give an optimum profit, which will avoid misspend money. It also to recognize and list down all the materials needed to effort by making some arrangement for the quantity and quality of material needed and recognized supplier.

36

4.1 FLOW CHART OF OPERATION ACTIVITIES It is schematic representation of the operation process from the start until the end. Ready of broiler closed house

Install the necessary brooding equipment

Received a day-old-chick (DOC)

Keep DOC in broiler close house

Check the chick quality

Daily control and quality control

Waiting for a growing process

Catching process

Distributor takes back the chicken

Disinfection process

37

FLOW CHART CONVENTIONAL SYMBOLS

o
V

SYMBOL

ACTIVITY

DESCRIPTION

Material are being OPERATION processed of planning and calculating

Received and return the TRANSPORTATION chicken to the supplier and delivered it to the customer Inspection on the size, weight, quality of the INSPECTION chicken we ordered and delivered

DELAY

Waiting a growing process

Material and property are STORAGE stored in the storage

38

PROCESS FLOW CHART 1) Ready of broiler closed house

2) Install the necessary brooding equipment

3) Received a day-old-chick (DOC)

4) Keep DOC in broiler close house

5) Check the chick quality

6) Daily control and quality control

7) Waiting for a growing process

8) Catching process

9) Distributor takes back the chicken

10) Disinfection process

39

4.2 OPERATIONS SYSTEM 1) Ready of broiler closed house. Our breeding project of day-old-chick required our company to build pens on 2.273 acres. Before we have building and planning construction of a boiler house,

firstly we select a site that is on well-drained land and has plenty of natural air movement. The house should be oriented on an east-west axis to reduce the amount of direct sunlight on the sidewalls during the hottest part of the day. The house is singlestorey and has a wide of 350 feet x 40 feet x 7 feet. The design is such that chickens are not exposed to injury. This is close house system, so there is an alarm signal. These alarm signals are useful to give a warning during a blackout. Then the generator will be used to provide a power electric.

40

2) Install the necessary brooding equipment

a) Drinker System This system providing clean, cool water with adequate flow rate is fundamental to good poultry production. Without adequate water intake, feed consumption will decline and bird performance will be compromised. Our company has used closed systems {nipple systems).The nipple drinkers operate at a flow rate of 50 to 60 ml/min. The pressure is adjusted to maintain water flow to meet the broiler's water needs and to adjust it, we use regulator. Nipple drinkers will be adjusted to suit chick height and water pressure. It must have evenly distributed pressure optimized for output without contributing to excessive dripping.

41

b) Feeding System Our company has used auto pan feeding system. This system is allowing for unrestricted bird movement throughtout the house, has a lower incidence of feed spillage, and improved feed conversion. In addition, pan feeders fill simultaneously minimizing bird competition when the feed lines are charged. Automated chain feeders allow for a minimum of 2.5 cm (lin) feeder space per bird. The maintenance of feed track, corners, and chain tension is essential. If the height is not adjusted properly, it can restrict bird movement within the house. The feed depth is controlled by feed slides in the hoppers and will be closely monitored to prevent feed wastage.

L-

42

c) Pad Cooling System We have to monitor level of ammonia, carbon monoxide, carbon dioxide, hydrogen sulfide and oxygen. In closed house system from time to time to ensure it does not affect health of chickens and workers. When the thermostats or probes detects the temperature below 30C the water will be automatically flow out from the front of the pens. The machine is calling the pad cooling system. Then the exhaust fan will pull out any gases and air that are not at the good level. The suitable temperature is according to stage of growth.

43

3) Chick Placement We buy a chick from our head company, Pertanian Pertiwi. This day-old-chick will be sending to us more than 18000 of chicks. These chicks are from same flock or same age. The delay in placement can contribute to the dehydration of chicks, resulting in higher chick mortality and reduced growth rate. Chick must be carefully placed and evenly distributed near feed and water throughout the brooding area. The light will be brought to full intensity within the brooding area once all chicks have been placed. We have to monitor the distribution of the chicks closely during the first few days. This can be used as an indicator for any problems in feeder, drinker, ventilation or heating systems.

4) Chick Quality Two hours after chick placement, we will be checking their quality. This is to ensure they are comfortable with the temperature. Chicks too warm will try to move away from heat, will be panting, will appear quiet and their wings may drop. Chicks too cold will crowds towards the heat, will huddle in groups and be noisy. While, chicks at the correct temperature will be evenly spread, show varied behavior (eating, drinking, resting and interacting) and will be softly chirping. Characteristics of a good quality chick are well dried, long fluffed down, bright round active eyes, look active and alert, have completely healed navels, free of red hocks and should be free from deformities.

44

5) Daily Control and Quality Control

a) Ventilation In order to the proper temperature, ventilation needs to be considered. Ventilation distributes heat throughout the house and maintains good air quality in the brooding area. We have to monitor level of ammonia, carbon monoxide, carbon dioxide, hydrogen sulfide and oxygen. In closed house system from time to time to ensure it does not affect health of chickens and workers. When the temperature transducer detects the temperature below 30C the water will be automatically flow out from the front of the house. The machine is calling the cooling pad system. Then the exhaust fan will pull out any gases and air that are not at the good level. The suitable temperature is according to stage of growth

Description Temperature Air speed Thermostat

Weekl 33C <50 ft/min 34C

Week 2 32C 100 ft/min 32C

Week3 29C 200 ft/min 30C

Week4 29C 300 ft/min 30C

Week5 29C 400-500 ft/min 30C

Exhaust Fan

45

b) Feed and Water Our broiler management is always making sure that both the feeders and drinkers are in adequate supply relative to the stocking density and are approximately placed. The nipple drinkers would be at chicks' eye level for the first 2 to 3 days of age and then maintained slightly above chicks' head. Pressure would be such that there is a droplet of water suspended from the nipple but no leakage. The birds' feet are always being flat on the litter and a bird will never have to stand on its toes to drink. Feed are provides in crumb form and placed on trays. Feeders will be raised incrementally throughout the growing period so that the pan is level with the bird's hack at all times. The feed level within the feeders will be set so that feed is readily ivailable while spillage is minimized.

46

c) Light Light intensity will be minimum of 20 lux (2 foot candles) in the darkness place in the brooding area during the brooding phase. Light intensity, distribution, color and duration affect the performance and welfare of the flock. Proper light placement and distribution will encourage chicks to find feed, water and warmth during the brooding phase.

d) Disease Control The veterinary will come every week to monitor disease status in house on a schedule basis. The culled chicken will be separate before its spread. The antibiotic or vaccine will be put in water. The use of the correct medication and the timing of treatment can be crucial in combating a disease problem. The preferred choice of a drug or antibiotic for some disease may be harmful if used for the treatment of others.

e) Bio-security Bio-security is the term used to describe an overall strategy or succession of measures employed to exclude infectious diseases from a production site. Outlined below are the key points that make us successful in bio-security program. > Keep door and gate lock at all times. > Farms are fenced. > No pet animal that are allowed in or around poultry housing. > Limit non-essential visitors to the farm. > If equipment must come from another farm, it would be thoroughly cleaned and disinfected before it comes onto the farm. > Farms have a toilet and hand washing facilities separate from the poultry house.

47

6) Growing Phase a) Uniformity Uniformity is measure of the variability of bird size in a flock. The coefficient of variation (CV) is commonly used to describe variability within a population. A low CV indicates a uniform flock whereas a high CV indicates an uneven flock.

Coefficient of Variation CV% = standard deviation

To estimate the CV of a flock, we will divide the house into three sections. A random sample of approximately 100 birds from each section, or 1% of the total population will be weighed and the individual weights recorded. It is important to weigh all birds within the catch pen excluding culls. Birds will be weighed daily for the first two weeks of age and weekly thereafter.

Flock Uniformity

CV 8 10 12

Uniformity 80% 70% 60%

Evaluation Uniform Average Poor uniformity

b) Modification of Feed and Nutrient Intake Adjusting dietary nutrient density or the physical form of the feed (mash vs. pellet) will influence broiler growth rates. Lower nutrient density diets may have a negative impact on feed conversion and yield but will cost less to produce. An analysis of dietary cost versus bird performance is essential in determining the best option.

48

c) Lighting Programs Lighting programs are a key factor in proper broiler management and are fundamental to optimal performance. Lighting programs are typically designed with changes occurring at predetermined ages and tend to vary according to the final target market weight of the broilers. Description Weekl 23 hours Light || 0600 Week 2 20 hours Week 3 18 hours Natural sun light Week 4 Week5

gj 0300 till g} 0100 till

morning morning

7) Catching Process Feed withdrawal will take place 8 to 12 hours before processing to reduce carcass contamination. The purpose of feed withdrawal is to empty the digestive tract, preventing ingesta and /or fecal material from contaminating the carcasses during the evisceration process. When birds are fasted between 8 and 12 hours, the intestine is almost completely empty yet strong enough to withstand the evisceration process without rupturing.

Preparation for catching > Water must be available until the start of catching ^ Lighting will be dimmed at the time of catching. If dimming is not feasible, the use of blue or green bulbs will clam birds and reduce activity. > Remove or raise all equipment that may interfere with the catch crew. > Careful management of the ventilation system is needed during catching to ensure adequate house ventilation.

49

Dark strip curtains hung over the doors block out light during daytime catching. These allow birds to remain quiet and will facilitate better ventilation. Lightweight curtains can be used to partition the house into smaller pens. This can reduce bird stress and diminish the risk of piling. Birds will be carefully placed in clean crates or modules.

8) Disinfection House will be disinfected thoroughly after every production cycle and left empty for a suitable period of time (can stop breeding cycle of disease carrier) before a new flock is brought in. Normally about 2 week. All farm equipment disinfected thoroughly after use and kept in a clean and dry place.

43 BUSINESS OPERATION TIME

Our business operation starts from 9.30 am - 5.30 pm. We picked this time as it is the appropriate time for any company / business to start and close their business daily. In the daytime, chicken will be cared and well kept by our experienced workers to make sure the safety and health of the birds. At night, they are allowed to roam and wander in the farm but adequate food and water are still provided. They are the most convenient animal to breed.

Operation time: Monday - Friday : 9.30 am - 5.30 pm

Saturday - Sunday : 10.30 am - 4.30 pm

Our operations include the process of feeding, health care and breeding.

50

4.4 CAPACITY PLANNING

Below are the lists for cost of raw material per chicken: Raw Material i.
11.

Cost per chicken (RM) 1.05 0.60 1.38 1.32 1.25 0.20 5.80

Day Old Chicks Starter Feed Pre-Grower Feed Grower Feed Finisher Feed Vaccine and Medication

iii. iv. v. vi. Total

Average weight of a big chicken is 2.3 kg, Total of raw material per chicken's weight = RM 5.80 / 2.3 kg = RM 2.52

COST OF RAW MONTH NO OF UNIT (kg) January-February March-April May-Jun July-August September-October November-December TOTAL YEAR 1 TOTAL YEAR 2 TOTAL YEAR 3 41,400 41,400 41,400 41,400 41,400 41,400 248,400 248,400 250,500 MATERIAL PER CHICKEN (RM/kg) 2.52 2.52 2.52 2.52 2.52 2.52 2.52 2.52 2.52 104,328 104,328 104,328 104,328 104,328 104,328 625,968 625,968 631,260 AMOUNT (RM)

51

4.5 TOTAL COST MONTH January-February March-April May-Jun July-August September-October November-December TOTAL AMOUNT 104,328 104,328 104,328 104,328 104,328 104,328 625,968

4.6 MATERIAL REQUIREMENTS (INPUT)

The following are the input of the operation process.

Raw Material i. ii. iii. iv.

V.

Cost per chicken (RM) 1.05 0.60 1.38 1.32 1.25 0.20 5.80

Day Old Chicks Starter Feed Pre-Grower Feed Grower Feed Finisher Feed Vaccine and Medication

vi. TotalI

52

4.7 LIST OF OPERATIONS PERSONNEL

POSITOIN Operation Manager Farm Workers

NO. OF PERSONNEL 1 2

4.8 SCHEDULE OF TASKS AND RESPONSIBILITIES

POSITION

RESPONSIBILITY/DUTY > Gives a good co-operation as to maintain the smoothness of the operation > To make sure the entire auto pan feeding system, nipple drinking system, brooding system and control system are in good

Farm Workers

condition. > To make an immediate report on machine, equipment or other damages. > Gives a food or other daily routine at the applicable time. > Always obey the rules that fixed by company.

53

4.9 SCHEDULE OF REMUNERATION

POSITION

NO.

MONTHLY SALARY (RM)

EPF 12% (RM)

socso
2.5% (RM)

TOTAL

Operation Manager

1,300

156

33

1,489

Farm Worker

500(each)

120

25

1,145

TOTAL

2^00

276

58

2,634

54

4.10 MACHINE AND EQUIPMENT

a) Infrastructure Development

Cost (RM)

i. ii. iii. iv.

Construction of access road Land clearing Fencing Main Drain System TOTAL

6,000 10,000 15,000 8,000 39,000

b) Equipment and Machinery

TOTALCOST ITEM 1 1.1 1.2 1.3 1.4 1.5 1.6 TYPES PAD COOLING SYSTEM 50" fan 1.0 hp 380 V with auto shutter Cooling Pad 6"x 24"x 60" 5'xl0' S.S Frame for Cooling Pad Water tank with capacity of 150 gallon Install connection of water pipe Water pump 1.0 hp Total for item no. 1 2 BOTH SIDE CURTAIN Total for item no.2 6,200 8 80 8 2 1 2 28,000 NO. (RM)

55

3 3.1 3.2

AUTO PAN FEEDING SYSTEM Feed Hopper 336' steel pipe complete with plastic pan and 0.5 hp motor 3 3

3.3 3.4

Hand winch Height adjusted of the auto pan feeding system-336'

3 3

3.5 3.6

1 Gallon Drinker for day-old-chick Square chick tray for day-old-chick Total for item no.3

200 200 23,000

4 4.1 4.2

NIPPLE DRINKING SYSTEM Regulator Nipple water PVC pipe and aluminum bar 340' long. 4 4

4.3 4.4

Hand winch Height adjusted system-336' Total for item no. 4 of the nipple drinking

4 4

14,600

5 5.1

BROODING SYSTEM Brooder gas Total for item no. 5 15 4,200

6 6.1 6.2 6.3

CONTROL SYSTEM Control system for 50" exhaust fan Control system for water pump Control system for Pan Feeding Total for item no. 6 1 1 1 8,000

7 7.1 7.2 7.3

ELECTRICAL SUPPLY Sub-board Lamp Lamp post 1 50 2

56

7.4

Electrical wiring for lamp, fan and water pump in broiler closed house. Total item for no.7 12,000

8 8.1

GENERATOR 1 unit Gen-Set Total for item no. 8 1 10,000

9 9.1

WATER SUPPLY 1 unit water tank Total for item no.9 1 5,000

10 10.1 10.2

Others Trolley Safety gear and tooling TOTAL FOR ALL ITEM 2 200 2,000 113,200

Therefore the total costs are; Cost of Infrastructure Development + Cost of Equipment and Machinery = RM 39,000 + RM 113,200 = RM 152,200

57

4.11 OPERATIONS SPACE LAYOUT PLAN (BROILER CLOSED HOUSE)

o o

KEYS
Storage and Control Room

Feed Hopper

[]

0.5 HP Motor
Regulator

Auto Pan Feeding Lines

Nipple Line

50" Exhaust Fan

Plastic pan

Water tank

Cooling Pad 58

4.12 OPERATION OVERHEAD

Below are the lists of estimated broiler production cost for overhead expenses: Types i. ii. iii. iv. v. Total Electricity Water Wood Shaving Catching Crew Gas for brooding Cost per chicken (RM) 0.20 0.08 0.08 0.15 0.08 0.59

Total costs for operation overhead are: = RM 0.59 X 18,000 chickens + Maintenance of Machinery + Miscellaneous = RM 10,620+RM 250 +RM 200 = RM 11,070

NO.

ITEM

AMOUNT PER MONTH (RM)

UTILITY 1.1 Water 1.2 Electricity

5,040

2 3

MAINTENANCE OF MACHINERY TOOLS AND DYES 3.1 Wood shaving 3.2 Gas for Brooding

250 2,880

4 5

PARTIME WORKER (3 catching crew) MISSELLANEOUS TOTAL

2,700 200 11,070

59

4.13 OPERATION BUDGET

FIXED PARTICULARS ASSET COST (RM) Fixed Asset > Equipment and Machinery > Infrastructure Development Working Capital > Purchase of Material > Salaries, EPFand SOCSO > Operation Overhead Other Requirements > Deposit > Other Expenses TOTAL 152,200 116,543 7,500 276,243 5,000 2,500 5,000 2,500 11,070 11,070 1,145 1,145 104,328 104,328 39,000 39,000 113,200 113,200 MONTHLY EXPENSES (RM) OTHER EXPENSES (RM) TOTAL

60

61

5.0 INTRODUCTION

The most crucial before starting a new business is how to get the capital and how the capital will be use. Financial system is basic thing or features in a business and it is the main source to control the journey of a business. A complete set of account which is related with the organization journey will be prepared by the chosen Financial Manager; to financial statement every year. It will show the profit or loss of our company, assets, liabilities and the stability and growth of our company's financial to make it faster. Besides, financial system can give us clear picture about return of capital that will be gain or capital investment that has been done. The information of financial plan is gathered on the input from the "ministrative budget, marketing budget and operation budget. In the financial, we have prepared the working paper, schedule and financial itement. The statements are:

> Project cost schedule of the project > Sources of financial > Schedule of loan repayment > Schedule of hire purchase > Schedule of fixed assets depreciation > Cash flow pro-forma > Profit and loss pro-forma > Balance sheet pro-forma

62

OBJECTIVE
The objective of financial plan is; > To determine the amount of money to be invested that is the project cost. > To identified and propose the relevant source fund > To ensure that the initial capital is sufficient > As a guideline for implementation > To know whether the business is competitive or not ^ To determine the potential of the business to generate profit > Cash outflows and cash inflows in the business project > Hire purchase installment payment > Loan installment payment > Depreciation on the fixed assets > The company's capital structure > The total cost that we need to start the business > Cost or paid up capital involves for starting the business

63

5.1 PROJECT IMPLEMENTATION COST SCHEDULE

RM
Capital Expenditures/Investment in Fixed Asset Land & Building Furniture Office and Equipments Infrastructure Development Sign Board Machinery Total 13 8,000 2,180 6,670 39,000 500 113.200 299,550

Working Capital/Monthly Expenses (for 2 month) Administrative Marketing Operation Day-old-chick (DOC) Total Other Expenses Deposit Company Registration & license Fees Other Expenses for operation Business Card 5,000 100 2,500 100 7,700 7,302 372,410 14,128 400 24,430 18.900 57,858

Total
Contingencies (2%) TOTAL

64

5.2 SOURCE OF FINANCE SCHEDULE

Equity Contributions

RM

RM

Partners Contribution: Mohamad Shukry bin Maksah Muhammad Fairuz bin Johari Muhd Nurfaiz bin Baharuddin Ahmad Luqman bin Mahammed Shaihani Sub-Total 34,910.00 15,000.00 15,000.00 15,000.00 79,910.00

External Sources Bank Loan Existing asset Sub-Total 290,000.00 2,500.00 292,500.00

TOTAL SOURCES OF FINANCE

372,410.00

65

5 3 SUPPORTING SCHEDULES

LOAN OF AMORTIZATION SCHEDULE

Total Loans: RM 290,000.00 Interest rate: 4 % Duration Method : 4 years / 48 months : Flat Rate Method TOTAL REPAYMENT 84,100 84,100 84,100 84,100 0 0 0 -

YEAR 1 2 3 4 5 6 7

PRINCIPAL 72,500 72,500 72,500 72,500 0 0 0

INTEREST 11,600 11,600 11,600 11,600 0 0 0

BALANCE 217,500 145,000 72,500 -

66

FIXED ASSET DEPRECIATION SCHEDULE

Type of Asset : Furniture Actual Price : RM 2,180.00

Economic Life: 5 years Method : Straight Line Method

Year

Yearly Depreciation

Total Depreciation (RM)

436

Balance (RM)

1 2 3 4 5

436 436 436 436 436

RM 1,744.00 RM 1,308.00 RM 872.00 RM 436.00

872

1,308

1,744

2,180

67

Type of Asset : Equipment Actual Price : RM 6,670.00

Economic Life: 5 years Method : Straight Line Method

Year

Yearly Depreciation

Total Depreciation (RM)

Balance (RM) 5,336.00 4,002.00 2,668.00 1,334.00

1 2 3 4 5

RM 1,334.00 RM 1,334.00 RM 1,334.00 RM 1,334.00 RM 1,334.00

1,334.00 2,668.00 4,002.00 5,336.00 6,670.00

68

Type of Asset : Signboard Actual Price : RM 500.00

Economic Life: 5 years Method : Straight Line Method

Year 1 2 3 4 5

Yearly Depreciation RM 100.00 RM 100.00 RM 100.00 RM 100.00 RM 100.00

Total Depreciation (RM) RM 100.00 RM 200.00 RM 300.00 RM 400.00 RM 500.00

Balance (RM) RM 400.00 RM 300.00 RM 200.00 RM100 .00 -

69

Type of Asset : Machinery Actual Price : RM 113,200

Economic Life: 5 years Method : Straight Line Method

Year 1 2 3 4 5

Yearly Depreciation RM 22,640.00 RM 22,640.00 RM 22,640.00 RM 22,640.00 RM 22,640.00

Total Depreciation <RM) RM 22,640.00 RM 45,280.00 RM67,920.00 RM90,560.00 RM113,200.00

Balance (RM) RM 90,560.00 RM 67,920.00 RM 45280.00 RM 22,640.00

70

Type of Asset : Infrastructure Development Actual Price : RM 39,000

Economic Life: 5 years Method : Straight Line Method

Year 1 2 3 4 5

Yearly Depreciatioii RM 7,800.00 RM 7,800.00 RM 7,800.00 RM 7,800.00 RM 7,800.00

Total Depreciatioii (RM) RM 7,800.00 RM 15,600.00 RM23,400.00 RMS 1,200.00 RM39,000.00

Balance (RM) RM 31,200.00 RM 23,400.00 RM 15,600.00 RM 7,800.00 -

71

5.4 PROFORMA FINANCIAL STATEMENTS CASH FLOW PROFORMA (ANUALLY)

Yearl (2006) Cash Inflows Owners' Capital(cash) Bank Loan Sales Collection of Accounts Receivable Total Cash Inflows Cash Outflows Administrative Expenditure: Salary, EPF, SOCSO Stationary Miscellaneous Telephone 79,910.00 290,000.00 394,496.00 361,560.00 YEAR 2 (2007) 394,496.00 394,557.00 YEAR 3 (2008) 406,725.00 405,706.00

1,125,966

789,053.00

812,431.00

76,968.00 600.00 1,200.00 6,000.00

76,968.00 600.00 1,200.00 6,000.00

76,968.00 600.00 1,200.00 6,000.00

Marketing Expenditure: Salary, EPF, SOCSO Miscellaneous

2,400.00

2,400.00

2,400.00

Operational Expenditure: Cash Purchases Salaries, EPF,SOCSO Operation Overhead Deposit Registration & Licenses Other Expenses Purchase of Fixed Assets - Land & Building Purchase of Fixed Assets - Others

113,400.00 13,740.00 132,480.00 5,000.00 100.00 2,600.00 138,000.00

113,400.00 13,740.00 132,480.00 _ 2,600.00 -

113,400.00 13,740.00 495,960.00 _ 2,600.00 -

159,050 .00

72

Loan Payment Principle Interest Total Cash Outflows EXCESS/(DEFICIT)

72,500.00 11,600.00 735,998.00 389,968.00

72,500.00 11,600.00 433,848 .00 355,205.00

72,500.00 11,600.00 776,668 .00 378,583.00

Opening Cash Balance Ending Cash Balance 389,968.00

389,968.00

745,173.00

745,173 .00

1,123,756.00

73

PROFORMA PROFIT AND LOSS ACCOUNT FRESH CHICKEN FARM Proforma Profit and Loss Account for the Year Ending 31 Dec 2006 RM RM
Sales

788,992 Less: Cost of Goods Sold Opening Stock Purchases Gross Profit Less Expense: Administration Expenses: Salary, EPF, SOCSO Stationary Miscellaneous Telephone Marketing Expenses: Salary, EPF, SOCSO Miscellaneous Operation Expenses: Salaries, EPF & SOCSO Operation Overhead Financial Expenses: Interest on Loan Depreciation on Fixed Assets Registration & Licenses Other Expenses Total Expenses Net Profit before Taxes Net Profit after Taxes Accumulated Net Profit

113,400

76,968 600 1,200 6,000

2,400 13,740 132,840 11,600 32,310 100 2,600 393,758 395,234 395,234 395,234

74

PROFORMA BALANCE SHEET ACCOUNT FRESH CHICKEN FARM

Proforma Balance Sheet for the Year Ending 31 Dec 2006 RM

Fixed Asset Land & Building Furniture Equipments Signboard Machinery Infrastructure Development Total Fixed Asset Current Asset Deposit Accounts Receivable Cash Total Current Asset Total Asset Owner Equity Capital (Owner's Equity) Accumulated Profit Total Equity Liabilities Loans balance Total Liabilities

138,000
1,744

5,336 400 90,560 31.200 267,240 5,000 32,936 389.968 427,904 695,144

82,410 395.234
477,644

217.500

217,500

TOTAL EQUITY AND LIABILITIES

695,144

75

Fi

Oil

76

CONCLUSION

Based on the business plan that has been done, we have not only shown the financial performance of this business but also the capability of the business. Because this kind of business is rather new, our company is confident that we can penetrate the market share.

From our observation, we also found that the Malaysian's stable economic situation and the Malaysian's fondness to try new type of food especially Chinese will help to encourage our business to grow. Adding to the fact that chicken's meat is lower in cholesterol that any other meat found in the market, we are also confident that this will also attract the health-conscious people to try this new alternative food.

The organization team for FRESH CHICKEN FARM consists of 4 dedicated, disciplined and motivated individuals with the same aim of strengthening the company.

As a conclusion, we strongly believe that FRESH CHICKEN FARM has a potential in running this business and has the competitive edge to succeed.

77

,\

I)

78

The environment of location before the project being proceeds

4- The location under construction.

4- Our products.

Mohammad Shukry B. Maksah No. 41, Jalan Sri Damak 50, Taman Sri Andalas, 41200 Klang Selngor

To Whom It May Concern.

Dear Sir,

Agreement on using land at Lorong Sarkawi, Jalan Kebun, Klang Selangor.

I am, Siti Bt Hj. Abdul Rahman as the owner of the land located above, agree to let my niece to develop that unoccupied land to open a broiler house with some incentives as in return. I will not be accused if they had a problem or involved in problem.

Thank You,

Your Faithfully

SitiBtHj. Rahman (No. VC: 4297581)

October 2, 2005 FRESH CHICKEN FARM Lot 3307, Batu 7, Lorong Sarkawi, Jalan Kebun, 42450, Klang Selangor Darul Ehsan.

Dear FRESH CHICKEN FARM,

Contract Farming With FRESH CHICKEN FARM At Jalan Kebun, Klang, Selangor

We are please to inform you that we have accepted your proposal to rear 18,000 birds/ flocks about 1 house on a piece of land specifies above with the concept of new broiler closed house. You will have to construct the chicken's house according to Pertanian Pertiwi Sdn. Bhd. Specifications and will sign a Contract Farming Agreement with Pertanian Pertiwi when the construction of the chicken house is completed. The company will then supply you day-old-chicks and feed according to the agreement that will be signed when you have complete construct your chicken house. We will market all the birds when they reach market size.

Thank you.

Yours faithfully, Mr. Liau Chai Peng Branch IManager(Klang) Pertanian Pertiwi Sdn. Bhd.

T
(I.an.1 )0)

IM -REGISTER,
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ATD (ISO)

SAMBUNGAN SELARI

RAOAS TELEFON TAMBAHAN

PERKHIDMATAN

Jems/Model Bil Nombor Utama

P ABX

Bil Sambungan Bil Stesen

KEY TELEFON

Bil. Norpbor Auxiliary

PERKHIDMATAN TELEMATIC

PERKHIDMATAN

Jems/Model Radas

Jems/Model Modem

Catatan "

DATEL TELETEKS TELEFAX

Menggunakan Nombor Telefon yang sediada

I"

PERKHIDMATAN TELEKS

Jems Radas

Cadangan Kod Jawab-Balik

KEMUDAHAN TAMBAHAN/CIRI-CIRI KHAS DIKEHENDAKI .

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Bulan

Han

Tandatangan Pemohqn

TANDAKAN ( ^

) DALAM KOTAK YANG BERKENAAN

Jika menggunakan radas sendirf, sila kemukakan surat pembekal. Cuma radas Kelulusan STM/JTM (Kswasolia) boleh digunakan.

PNA. 42 PEJA&AT PENDAFTAR PERNIAGAAN

Permohonan Kelulusan Nama Perniagaan
(Tiada Bayaran Dikenakan)

Saya memohon menggunakan salah satu nama-nama perniagaan dibawah: (a) (b) (c) * Nama dan Alamat Pemiiik / Pekongsi
((.junakan lampiran lamjika pemiiik lebih 3 orang)

* No. Kad Pengenalan & Wama Baru: . Lama:

(a)Nama: Alamat:

(b)Nama : Alamat:

Baru: Lama:

(c)Nama : Alamat:

Baru: Lama:

* Jenis perniagaan dijalankan :

# Tarikh

* Tandatangan Pemohon : Nama : No. K/P :

# No. Rujukan: # No. Rujukan:

# Catatan :

Tarikh: (

Penolong Pendaftar Perniagaan

+ Sila lihat syarat kelulusan dimuka sebelah. * Pemohon hendaklah melengkapkan ruangan-ruangan ini. # Ruangan ini dibiar kosong. Kuala Lumpur

Syarat-syarat Kelulusan
1. Permohonan nama perniagaan yang tidak meraenuhi syarat di bawah akan ditolak: a. b. c. d. e. 2. 3. 4. Nama perniagaan tidak bersesuaian dengan jenis perniagaan yang dijalankan. Nama yang dipohon telah digunakan oleh peniaga lain. Menggunakan nama diri yang bukan nama sebenar pemilik. Menggunakan perkataan yang dikawal oleh Pendaftar. Nama yang tertakluk di bawah Kaedah Pendaftaran Perniagaan 1957.

Nama yang diluluskan tidak boleh dipinda/ditambah perkataan atau huruf. Kelulusan ini tidak boleh dipindah milik kepada orang lain. Permohonan baru perlu dibuat jika perniagaan tidak didaftarkan selepas tamat tempoh kelulusan nama perniagaan. Permohonan yang mempunyai perniagaan lain yang telah tamat tempoh laku Sijil Perakuan Pendaftarannya hendaklah memperbaharui Sijil Perakuan itu dahulu atau memfailkan Borang ' C . Pemilik/Pekongsi mestilah bermastautin di negeri di mana perniagaan dijalankan.

5. 6.

KELULUSAN INI MENJADI BATAL JIKA SATU ATAU SEMUA SYARAT DI ATAS TIDAK DIPATUHI.

KAEDAH-KAEDAH PENDAFTARAN PERNIAGAAN 1957 (KAEDAH 3)

PENDAFTARAN PERNIAGAAN

UNTUK KEGUNAAN PEJABAT NO.PERAKUAN

BORANG A
DIBIARKAN KOSONG

f>ENDAFTARAN PERNIAGAAN,

Saya/Kami yang bertanggungjawab menyerahkan butir-butir berikut mengenai perniagaan yang tersebut di bawah mi untuk didaftarkan. Saya/Kami menyerahkan Wang Kiriman/Wang Tunai sebanyak RM25/RM50 untuk bayaran pendaftaran dan untuk ^erakuan Pendaftaran. A. MAKLUMAT PERNIAGAAN
1. NAMA PERNIAGAAN

2. TARIKH MULA BERNIAGA

3. PERJANJIAN PERKONGSIAN (PILIH SATU) ADA (LAMPIRKAN SURAT PERJANJIAN) TARIKH TIADA

4. ALAMAT TEMPAT UTAMA/PENGKALAN PERNIAGAAN

4.1. BANDAR

4.2. POSKOD

4.3. NEGERI (KOD)

.5. ALAMAT SURAT-MENYURAT (JIKA BERLAINAN DARI DI ATAS)

15.1. BANDAR

5.2. POSKOD

5.3. NEGERI (KOD)

KAEDAH-KAEDAH PENDAFTARAN PERNIAGAAN 1957 (KAEDAH 3) B. MAKLUMAT'CAWANGAN

UNTUK KEGUNAAN PEJABAT NO PERAKUAN

PENDAFTARAN PERNIAGAAN

BORANG A
DIBIARKAN KOSONG ALAMAT CAWANGAN

1. BANDAR

1.2. POSKOD

1.3. NEGERI(KOD)

ALAMAT CAWANGAN

.1. BANDAR

1.2. POSKOD

1.3. NEGERI(KOD)

ALAMAT CAWANGAN

.1. BANDAR

1.2. POSKOD

1.3. NEGERI(KOD)

KAEDAH-KAEDAH PENDAFTARAN PERNIAGAAN 1957 (KAEDAH 3) C. IVIAKLUMAT PEMILIK

UNTUK KEGUNAAN PEJABAT NO. PERAKUAN

PENDAFTARAN PERNIAGAAN

Nota: Tiap-tiap pemilik hendaklah mengisi butir-butir bahagian ini dalam helaian berasingan.

BORANG

DIBIARKAN KOSONG 1. NAMA PEMILIK 2. JANTINA LELAKI PEREMPUAN

3. NO. PENGENALAN DIRI KAD PENGENALAN (BARU) PASPORT POLIS TENTERA

KAD PENGENALAN (LAMA)

4. WARNA BIRU MERAH LAIN-LAIN

5. TARIKH LAHIR

6. ALAMAT KEDIAMAN

6.1. BANDAR

6.2. POSKOD

6.3. NEGERI (KOD)

7. BANGSA MELAYU

6. KERAKYATAN MALAYSIA

9. PEMILIKAN KETUANPUNYAAN TUNGGAL KONGSI UTAMA

CINA

PENDUDUK TETAP (NYATAKAN NEGARA ASAL)

INDIA

KONGSI BIASA

BUMIPUTERA SABAH 10. TANDATANGAN PEMILIK BUMIPUTERA SARAWAK

LAIN-LAIN (SILA NYATAKAN)

KAEDAH-KAEDAH PENDAFTARAN PERNIAGAAN 1957 (KAEDAH 3) t). MAKLUMAT JENIS PERNIAGAAN

UNTUK KEGUNAAN PEJABAT NO. PERAKUAN

PENDAFTARAN PERNIAGAAN

UNTUK KEGUNAAN PEJABAT KOD JENIS PERNIAQAAN

BORANG

A
DIBIARKAN KOSONG DIBIARKAN KOSONG

I. JENIS PERNIAGAAN

2. TARIKH

KAEDAH-KAEDAH PENDAFTARAN PERNIAGAAN 1957 (KAEDAH 3) E. PENGESAHAN OLEH SEKUTU-NIAGA

UNTUK KEGUNAAN PEJABAT NO. PERAKUAN

PENDAFTARAN PERNIAGAAN

BORANG A
DIBIARKAN KOSONG

Saya/Kami yang bertandatangan di bawah ini mengesahkan bahawa segala kenyataan yang dibuat dalam borang ini adalah tepat dan mengaku bahawa saya/kami adalah sekutu dalam perniagaan bernama

NAMA PENUH

NO. KAD PENGENALAN/WARNA

TANDATANGAN/CAP IBU JARI KANAN

Saya mengaku bahawa tandatangan/cap ibu jari kanan di atas telah diturunkan pada akuan di atas ini di hadapan saya setelah saya berpuashati bahawa orang yang menurunkan tandatangan/cap ibu jari kanan itu adalah sebenarnya Drang yang namanya tersebut dalam akuan itu dan ia/mereka faham maksud akuan itu.

Bertarikh di.

.pada.

.haribulan

. tahun.

NAMA : JAWATAN : ALAMAT :

(TANOATANGAN DAN COP RASMI PEGAWAI PENGESAH)

Catatan: Pengesahan di atas hendaklah disaksikan oleh - Ahli Parlimen atau Ahli Dewan Undangan Negeri, Hakim, Majistret, Pegawai Kumpulan Pengurusan dan Profesional, Peguambela atau Peguamcara, Penghulu, Penggawa, Jaksa Pendamai (J.P), atau Pesuruhjaya Sumpah.

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991 BORANG PENDAFTARAN AH LI KEGUNAAN KWSP 10. MAJIKAN. NO. AHL1:

KWSP 3 (AHL)

fama Ponuii I'ekcrja: NO. Kad Pengehalan: o. K/P Lamu/Paspot: A'arganegara: Jantina: Tarikh Lahir: _ Keiurunan

UNTUK KEGUNAAN KWSP

I KWSP 3 [
I Mama Ringkas

KWSP 4

j T'/tangan Pengesah: j Jaw at an: I'arikh: CAP IBU JARI AJHLI

ku d a n m o n i v s a h k a n b a h a w a bu{'::.-:\':;;ai J; aia^ -idaiah beiul d a n ')cn;:r u! iVm..'. liul..:' boiiau d a n k c d u a C'-.i|i
i b i i .!.;! in'>; i - i i i n d i ; i i r ' i n k ; i ' ! d i h a d a p a n say a.

S:i\a m c n e a k u b a h a w a b u l i r - b u l i r vanu tcrcai ! il di alas adalah bctul dan benai mcngikut KaJ

K1RI

KANAN

reii;:en<iian S

Tandatangan: . (Majikan. Wakil Majikan atau Pegawai KWSP)

Tandatangan: (Pekerja) Tarikh:

Jawatan: No. K/Pengenalan: Tarikh:

L1HAT DI B F L A K A N G
i ' i KM <v'i.-v'--: A d'P i \ K A N i-:.AI") i'lN(,I'.N;\LA\.

.i A NIC i A N D l i ' L K A I K A N

MA A1ILI': LA.MAT All LI:

TUAN/PUAN yNDAITARAN K W S P 3 lAdalah d i m a k l u m k a n pecniohonan T u a n / P u a n untuk menjadi ahli K W S P telah diterima dan kad keahlian akan dihantar epada T u a n / P u a n sebaik sahaja urusan pendaftaran telah d i s e i n p u n i a k a n . ckian.

f.p l'engernsi Hksekutif Lembaga Kunipulan Wang Simpanan Pekerja. tarikh:

ALAMAT TUAN/ PUAN POSKOD BANDAR NEGERI NO. TELEFON

ALAMAT WARIS TERDEKAT: POSKOD BANDAR NEGERI NO. TELEFON

PERHATIAN: SEKIRANYA TUAN/PUAN TELAH BERPINDAH ALAMAT, SILA ISIKAN BORANG KWSP 1866 DAN HANTAR KE PEJABAT KWSP YANG BERHAMPIRAN DENGAN TEMPAT TINGGAL TUAN/PUAN.

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991 BORANG PENAMAAN

Sava (NAMA AHLI) menamakan mdividu seperti disebutkan keatas diri sava. NAM A di bawah un'uk menerima simpanan KWSP apabila berlaku kcniatian
No. K./P

KWSP4(A>!L)

dan No. Ahli

NO. K.P/SURAT BERANAK

PERTALIAN

BAHAG1AN

SILA LIHAT DI BELAKANG JANGAN DICERAIKAN

NAMA AHLI: ALAVIA'I AHLI:

TUAN/PUAN PENAMAAN KWSP 4 Adalah dimaklumkan penamaan Tuan/Puan bertarikh l.Telah didaftarkan 2.Tidak dapat didaftarkan kerana belum mencapai 18 tahun/borang tidak lengkap. Sekian.

b.p Pcnge.-usi Eksekutif Lenibaga Kumpulan Wang Simpanan Pekcrja. Tarikh:

Penamaan ini bertarikh

Hniibulan

20

membaf.ilkan penainaan yang tcrdahulu

AKUAN SAKSI KIRI Saya dengan ini mengcsahkan kenyataan di alas telah dibuat oleh ahli dan cap ibu jarinya telah diturunkan di hadapan sava. Nama penuh saksi: No k p saksi Pekerjaan: Alamat saksi:

CAP IBU JAR! AHLI KANAN

PERHATIAN: i) S e k i r a n y a c a p i b u j a r i k i r i / k a n a n r o s a k. si I a tandaiangani pada scbelahan cap ibu jari lersebut li) Jika s e o r a n g ahli K u m p u l a n Wang yang beragama Islam mati dengan m e m b u a t p e n a m a a n mengikut P e r a t u r a n - p e r a t u n n m i , orang atau b e b e i a p a orang yang d i n a m a k a n itu h e n d a k l a h m e n e r i m a k i c d i t ahli \ a n g mati itu s e b a g a i s e o r a n g wasi dan b u k a n n y a sebagai b e n e f i s i a n dan hendaklah m e m b a h a g i - b a h a g i k a n kredit itu mengikut U n d a n g - u n d a n g Islam.

Tandatangan saksi. Tarikh, UNTUK KBGUNAAN KWSP SAIIAJA TARIKH TERIMA 'IARIKH DIDAFTAR

KEGUNAAN KWSP SAHAJA

1. NOMBORAHU

BUTIRAN AHLI 2 NOMBOR KAD PENGENALAN12 DIGIT

KP

! I I
3 NOMBORKADPENGENALAN7DIGIT

II I
4 NOf/BORPOUS/TENTERA/PASPORT/DSB

I I

I I

I I I

I
T
1

I I I

HURUFAWALAN NAMAAHU

5. NAMA MENGIKUT KAD PENGENALAN/PASPORT

I I

i II I II
6 SEKTOR KERAJAAN BEKERJASENDIRI SWASTA

I
TIDAK BEKERJA

I I
LI

1
LFLAKI

1I

I1
7.JANTINA PEREMPUAN

MOD PEMBAYARAN WARAN DRAF8ANKASING ARAHAN1 BAYARAN KREDITKEAKAUNBANK

1 2 3 4

KERAJAAN KETURUNAN

9 AMAUN YANG DIPOHON RINGGIT MALAYSIA

SEN

DISEMAKOLEH PEGAWAIPENYEMAK

10 ALAMATAHLI

1X11UJ
[ TTTTTT ITn

NO K/TGN

U_L
TARIKri DISAHKANOLEH PEGAWAIPENGESAH

T T l I 1 1 I 1 1 I I I I I II r i IT I TI I I I1 Li IT 1 LJLLXXl TTT rTXT"rrrT~rn~rT

POSKOD BANDAR NEGERI

n
12. NO K/TGN

11. NOMBOR TELEFON PEJABAT

NOMBOR TELEFON RUMAH/EIMBIT

T I I I I

Ll I I I I FTZ

ADALAH SAYA DENGAN INI MENGAKU JAN Jl SEPERTIBERIKUT 1 MEMATUHI SEMUA SYARAT YANG DIKENAKAN OLEH LEMBAGA Dl BAWAH SKIM IN' DAN MEMAHAMIDENOAN PEMIUHAN INI LEMBAGA TIDAK AKAN BERTANGGUNGJAWAB KE ATAS APA APA K LEMBAGA Dl ATAS KERUGIAN TERSEBUT 2 APA-APA AMAUN YANG OIPINDAHKAN TIDAK TERMASUK DALAM PENAMAAN SAYA 3 SAYA JUGA FAHAM BAHAWA SAYA TIDAK BOLEH MEMBATALKAN PSRVOHONAN INI

JENIS PENGELUARAN NOMBOR AHLI

I I I I I
TARIKH DILULUSKANOLEH: PEGAWAIPEI.U1.US1

NOMBOR

CAP IBU JARI KIRI DAN KANAN AHLI (MESTI DITURUNKAN DENGAN TERANG DAN PENUH MENGGUNAKAN

KIRl

KANAN

NO K/TGK

PAD CAP IBU JARI BERWARNA HITAM)

I II
TARIKH DILULUSKANOLEH PEGAWAIPELULUS2

TARIKH

13. UNTUK DIISI OLEH INSTITUSI PENGURUSAN DANA (IPD) KOD INSTITUSI PENGURUSAN DANA (RUJUK PANDUAN MENGISI BOR NG) NOMBOR AKAUN/NO RUJUKAN PEMOHON SAYA DENGAN INI MENGESAHKAN MAKLUMAT PDviOHON Dl ATAS LHH

i i i i i i i i i
COP RASMI

NO K/TGN

11
TARIKH

11
TARIKH

TANOATANGAN

NAMA PEGAWAI

PANDUAN UNTUK MENGISI BORANG KWSP 9 F (AHL) PEMBERITAHUAN PEMINDAHAN KREDIT UNTUK SKIM PELABURAN

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG BORANG PERMOHONAN MESTILAH DIPENUHI DENGAN HURUF BESAR.

Nombor Ahll Isikan sata digit di setiap ruang dengan didahului oleh dig.t '0' jika perlu seperti contoh di bawah 1. NOMBOR AHL! r Contoh 1234567 3 4 , 5 6
r

2.

Nombor Kad Pengenalan 12 Digit Isikan nombor Kad Pengeiialan 12 digit t u a n / p u a n digit, kosongkan rtiangan ini Contoh 610701-02-6157
6

Jlka t u a n / p u a n belum memiliki

Kad Pengtnalan 12

2. NOMBOR KAD PENGENALAN 1 0 1 7 , 0 1

0

1 I5

3.

Nombor Kad Pengenalan 7 Digit Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah 3 . NOMBOR KAD PENGENALAN 7 DIGIT a) b) c) d) 1234567 A 1234567 K 1234567 H 1234567
1

3 4 , 5 6 3 3 4 4 5 5
6 6

3 , 4

4-

Nombor Polis/Tentera/Pasport/Dsb Isikan Nombor Polis/Tentera/Pasport/Dsb termasuk huruf awalan, seperti contoh di bawah

4. NOMBOR POLIS/TENTERA/PASPORT/DSB a' b) I 1234567 T 1234567

* S 6 |7
5
(5

5.

Nama Mengikut Kad Pengenalan/Pasport Tuliskan nama tuan/puan seoagaimana yang tercalat dalam kad pengenalan tuan/puan Jlka sama menglkut kad pengenalan ialah Norman bin Abdullah sila tuliskan nama seperti di bawah 5. NAMA MENGIhUT KAD PENGENA1 AN/PASPORI N O R' M' A I N
N

1_

6.

Sektor Pekeriaan Tandakan ( V ) di dalam ruang yang disediakan. ( V ) dalam ruang berkenaan sepertl di bawah : Jlka tuan/puan bekerja dalam sektor swasta, tandakan

? SEKTOR PEKERJAAN BEKERJA SENDIRI I KERAJAAN SWASTA TIDAK BEKERJA

Jantina
Tandakan jantina tuan/puan dengan ( V ) dalam ruang yang disediakan. Jika lelaki, tandakan (V) di ruang yang berkenaan seperti di bawah : 7. JANTINA LELAKI PEREMPUAN

8.

Keturunan Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, Isikan seperti di bawah : 8. KETURUNAN 1

Melayu Cina India Lain-lain

1 2 3 4

Bidayuh Kadazan Iban

5 6 7

9.

Amaun Dipohon Isikan satu digit di setiap ruang dengan didahului oleh digit-digit '0' jika perlu. Jika amaun yang dikehendaki oleh tuan/puan untuk pemindahan pelaburan (setelah berunding dengan IPD) adalah RM13,170.00, isikan ruangan yang berkenaan seperti di bawah : 9. AMAUN DIPOHON RINGGIT MALAYSIA 0 0 0 SEN 0

10.

Alamat Ahli Tuliskan alamat surat menyurat tuan/puan dengan lengkap. Jika alamat surat menyurat tuan/puan adalah Lot 10 Kg Parit Kadir Timur, Bukit Pasir, 84300 Muar, Johor Daru) Takzim, sila penuhl seperti berikut : 10. ALAMAT AHLI

L T

O I

T M U

G K I

P T

R P

I T A S I

K R

POSKOD 8 4 3 NEGERI J O H

BANDAR M U A

11.

Nombor Telefon Isikan nombor telefon di ruangan yang disediakan dl bawah : Contoh : Nombor Telefon Pejabat : 07 - 9859450 Nombor Telefon Rumah/Blmbit : 016 - 2070158 11. TELEFON PEJABAT
8

_LLLLII I

TELEFON RUMAH/BIMBIT 1 7 0 - ! 2 0

12.

Jenis Fengeluaran. Nombor Ahli. Nombor Kad Pengenalan dan Cap lbu Jar! Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jarl berwarna hltam.

13.

BUTIRAN UNTUK DIISI OLEH INSTITUSI PENGURUSAN DANA

i.

Kod Instltusi Pengurusan Dana Isikan kod yang telah diperuntukkan oleh KWSP kepada Institusl Pengurusan Dana (IPD) : Contoh : Kod 'AIM Unit Trust Bhd" ialah 007 Isikan seperti berikut di kotak yang berkenaan Nombor Akaun / Nombor Rujukan Pemohon Tullskan nombor akaun / nombor rujukan yang diperuntukkan oleh IPD kepada pemohon. Contohnya : Jika nombor akaun pelaburan pemohon ialah 123456789100001, isikan ruangan seperti di bawah :
D 0 0

LI
HI.

0 ' 0

Pengesahan Nombor Pollsl / Nombor Rujukan Pemohon Turunkan tandatangan, tuliskan nama pegawai dan cop rasmi IPD serta tarikh pengesahan di ruangan yang disediakan.

n
NAMA NO. AHLI
1.0 PENTING 11 12 13 Borang permohonan yang telah lengkap diisi hendaklah diserahkan kepada Institusi Pengurusan Dana (IPD) yang dplih Salman dokumen hendaklah disahkan oleh pegawai Institusi Pengurusan Dana (IPD) yang dipilih Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam Tuan/puan hendaklah menurunkan cap ibu jan kin dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Jan berwarna hitam Tuan/puan hendaklah memastikan dokumer dokumen yang disertakan bersama-sama dengan borang permohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples) Semua sahnan fotostat dokumen hendaklah menggunakan kertas saiz A4 KWSP berhak menolak mana-mana permohonan yang tidak lengkap

TEL:(P)

(R),

14 15 16 2.0

DOKUMEN UTAMA Tandakan ( V ) dalam kotak yang berkenaan 21 Borang permohonan KWSP 9F(AHL) - 3 Salman (1 sahnan disimpan oleh IPD dan 2 salinan untuk kegunaan KWSP) 22 Salman Kad Pengenalan ajau Salman Kad Pengenalan Polis/Tentera dan Surat Pengesahan Majikan menyatakan nombor Kad Pengenalan Awam aan nombor Polis/Tentera merujuk kepada orang yang sama

Tandatangan Ahli Tandatangan Penenma

Tankh Tankh

KUMPULAN WANG SIMPANAN PEKERJA 1OGOS2001

KEGUNAAN KWSP SAHAJA

JENIS PENGELUARAN YANG DIPOHON: SILA TANDAKAN ( V ) Dl KOTAK YANG BERKENAAN

1. JENIS PENGELUARAN

KP
D E

1 2

PENDIDIKAN PENDIDIKAN ANAKAHU

HURUFAWALAN NAMAAHU 2.NOMBORAHLI

BUTIRAN AHLI
3, NOMBOR KAD PENGENALAN 12 DIGIT

rrrr\
MODPEMBAYARAN WARAN DRAFBANKASING ARAHAN8AYARAN KREDITKE AKAUN BANK

i I-I i i -i i
5. NOMBOR POUS/TENTERA/PASPORT/DSB

1 2 3 4

4. NOMBORKADPENGENALAN7DIGIT

niTTTT I I I ! I I
6. KETURUNAN

7.JANTINA LELAKI PEREMPUAN

JENIS AKAUN KONVENSIONAL AL-WADIAH

1 2

8. NAMA MENGIKUT KAD PENGENAUN PASPORT

PENERiMABAYARAN AHLI INSTlTUSIPENGAJIAN TiNGG! INSTITUSIPEMBERI PINJAMAN

II
1 2 3

I I I I I II I I
9.ALAMATAHU

i n i i n
POSKOD BANDAR

TTTTl r r r r
NEGERI

i i i i i i i i i TTITTTT
10. NOMBOR TELEFON PEJABAT

M I N I
NOMBOR TELEFON RUMAH/BIMBIT

I
DISEMAKOLEH: PEGAWAIPENYEMAK

I I I I I

I I

I I I
12. AMAUN DIPOHON UNTUK AHLI/ANAK AHLI RINGGIT MALAYSIA SEN

11. YURAN PENGAJIAN AHLI/ANAK AHLI RINGGIT MALAYSIA

SEN

I
CAW
UNIT

I I I I I

I I I I

1
NO. K/TGN

13. BAKIFINJAMAN PENDIDIKAN AHLI/ANAK AHLI RINGGIT MALAYSIA

14. JENIS PEMBAYARAN WARAN DRAFBANKASING ARAHANBAYARAN KREDITKE AKAUN BANK

SEN

I TTTI
TARIKH.

I I I I I

BUTIRAN AKAUN BANK (SEKIRANYA PEMBAYARAN DIBUAT KEPADA AHLI)

16. KOD BANK

16. NOMBOR AKAUN BANK AHLI

' i i i i i i i i i i i i i i i i i i i
17. JENIS AKAUN KONVENSIONAL AL-WADIAH

BUTIRAM PELAJAR (ANAK AHLI) (SEKIRANYA MEI1OHON UNTUK PENDIDIKAN ANAK) PEMBERITAHUAN DISAHKANOLEH PEGAWAIPENGESAH

niErn

18 NAMA PELAJAh Mf-Nbirs(JT KAD PENGENALAN

TTTTTTT
NO K/TGN 19 NOMBOR KAD PENGENAIAN 12 DIGIT

TARIKH 20 HUBUNGAN AH J DENGAN PELAJAR ANAK AMAKTIRI ANAK ANGKAT

BUTIRAN LAIN

DILULUSKANOLEH PEGAWAI PELULUS1

21 JAMA DAN CAWANGAN INSTITUSI PCNGAJIAN TINGGI

i i
22 PERINGKATPENGAJIAN P I

I
23 TAHUN PENGAJIAN

I I
H I

I I

I I

24 LOKASI PENGAJIAN

NO K/TGN

TARIKH

25 NAMA PAN CAWANGAN INSTITUSI DFMBERI PINJAMAN

1X1 II
1 2 PEGAWAI PELULUS 2 SAYA DENGAN INI MEMOhON UNTUKMENGELUA^KAN KREDITSAYADI KWSPtv'ENURUTPERUNTUKANAKTAKWSP 1991 SAYA JUGAAKAN PATUHKEHLNDAK SEKCYCN 54(6)(G) PERUNTUKAN AKTAKWSP 1991 SAYA MEMBFt ARK AN KWSP MEMBUAT BAYARAN TER JS KEPADA INSTITUSI PFNGAJIAN TINGGI ATAU PEMBERI PIN JAMAN Dl MANA YANG BERKtNAAN

26
JENIS PENGi-LUARAN NOMBOR AHII

N MO O BR

NO K/TGN
CAP IBU JARI KIRI DAN KANAN AHLI TARIKH (MESTI DITURUNKAN DENGAN TERANG DAN PENUH MENGGUNAKAN PAD CAP IBU JARI BERWARNA HITAM) KIRI KANAN

TARIKH

PANDUAN UNTUK MENGISI BORANG KWSP 9 H fAHLl PENGELUARAN PENDIPIKAN ANAK

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAH DIPENUHI DENGAN HURUF BESAR.

1.

Jenis Pengeluaran Yang Dipohon Tandakan ( V ) dlmana berkenaan

1.

1.
2.

JENIS PENGELUARAN PENDIDIKAN AHLI PENDIDIKAN ANAK AHLI

2.

Nombor Ahli Isikan satu digit di setiap ruang dengan didahului oleh digit '0' jika perlu, seperti contoh Con ton : 01234567 di bawah

2. NOMBOR AHLI
1 [_2 3 4 5 6 7

3.

Nombor Kad Pengenalan 12 Digit Isikan nombor Kad Pengenalan 12 digit tuan/puan. digit, kosongkan ruangan ini : Contoh : 610701 - 02 - 6157 3. NOMBOR KAD PENGENALAN 12 DIGIT o| 7|o o Jika tuan/puan belum memiliki Kad Pengenalan 12

4.

Nombor Kad Pengenalan 7 Digit 4.1 Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf avvalan, seperti contoh di bawah: 4. NOMBOR KAD PENGENALAN 7 DIGIT a)
b) c) d)

1234567
A 1234567 K 1234567 H 1234567

1 i 2 [ 3 ' 4 fs \ 6~J~7 3 4 1~5 ] 6 F 7

[K

T]2
1 I2!3 4| 5 6[ 7

5.

Nombor Polis/Tentera/Pasport/Dsb Isikan Nombor Kad Pengenalan Polis/Tentera/Pasport/Dsb tennasuk huruf awalan, seperti contoh di bawah: 5. NOMBOR/POLIS/TENTERA/PASPORT/DSB a) b) I 1234567 T 1234567

HID

6.

Keturunan Isikan ruang dengan menglkut kod keturunan di bawah lnl. Jika tuan/puan berketurunan Melayu, isikan seperti di bawah : 6. KETURUNAN| 1 Melayu Cina India Latn-lain
1 2 3 4

Bidayuh Kadazan lban

5 6 7

7.

Tandakan jantina tuan/puan c ngan ( \ ) dalain ruang yang disediakan U yang berkenaan seperti di bawah 7 JANTINA IELAKI I'F REMPUAW

Jika lelaki tandakan ( V ) di ruang

Nama Mengikut Kad Pengenalan/Pasport Tuhskan nama tuan/puan sebagaimana yang tercatat dalam kad pengenalin t u a n / p u a n Jika sama mengikut kad pengf nalan ulah Norman bin Abdullah sila tuhskan nania seperti di bawah 8. NAMA MENGIKUT KAO I 1 NGENAI AN/P<\SPORT
'] O | R T M7~A^~N I ] B 1 N A B | D U L ] L |~A ' H ' ^

9.

Alamat Ahli Tuliskan alamat surat menyural tuan/puan dcngan lengkap Jika ilamat surat menyurat tuan/puan adalah Lot 10 Kg Parit Kadir Timur Bukit Pasir 84300 Muai Johor Darul Tak/im Sila penuhi seperti berikut 9 ALAMAT AHLI P A R I Tr
I P A S

LiO

1 0

K[ G
_B J U K I BANDAR

K A
1 R 1 1 1

1 I I M |U IRI POSKOD

~8 4 ' 3}
NEGERI ^ , HTOI R!

M1 U [ A I R

j Q _J.T D

10.

Nombor Telefon Pejabat & Nombor Telefon Rumah Isikan nombor telefon pejabat dan uimah di ruangan yang disediakan di bawah Contoh Nombor Telefon Pejabat 07 9859450 Nombor Telefon Rumah/ Bimbit 10.
0 ' 7

016-2070158

TELEFON PEJABA1
r qT 8T" 9^4 5 0

0 i 1 ' 6

TELEFON RUMAH 'BIMB1T 2 , 0 7 0 1 5

11

Yuran Pengajian Ahli/Anak Isikan satu nombor untuk Uap tiap satu ruangan Nombor kosong (0) di hadapan perlu dituhskan dalam semua ruangan yang tidak dipenulu Jika yuian pengajian t u a n / p u a n atau anak t u a n / p u a n adalah RM12 000 00, isikan ruangan \ang bei kenaan sepeiti di bawah 11 MIRAN I'ENGA.JIAN AHLI/ANAK RINGGIT MALAYSIA T SEN

0 0 1J 2 l 0 0 I 0 Jo_O I

12.

Amaun Dipohon Isikan satu nombor untuk tiap-tlap satu ruangan. Nombor 'kosong' (0) di hadapan perlu dituliskan dalam semua ruangan yang tidak dipenuht. Jika tuan/puan memohon RM 10,000.00, isikan ruangan yang berkenaan seperti di bawah : 12. AMAUN DIPOHON RINGGIT MALAYSIA SEN _OJ 0 | 1 | 2 j 0 | 0 J 0 | 0 0

13.

Baki Piniaman Pendidikan Ahli/Anak Ahli Isikan satu nombor untuk tiap-tiap satu ruangan. Nombor 'kosong' (0) di hadapan perlu dituliskan dalam semua ruangan yang tidak dipenuhi. Jika tuan/puan memohon RM10.000.00, isikan ruangan yang berkenaan seperti di bawah : 13. BAKI PINJAMAN PENDIDIKAN AHLI/ANAK AHLI RINGGIT MALAYSIA I SEN [ Oj_ 0J_1 | 0 0 0 j 0 ' 0 I 0

14.

Jenis Pembayaran Tuan/puan boleh memilih salah satu cara pembayaran sepcrti berikut . Jika tuan/puan memllih Kredit Ke Akaun Bank, sila tandakan ( V ) di ruangan yang berkenaan : 14. JENIS PEMBAYARAN WARAN DRAF BANK ASING ARAHAN BAYARAN KREDIT KE AKAUN BANK

IS.

Kod Bank Isikan kod bank tuan/puan seperti contoh di bawah Jika kod bank tuan/puan adalah Maybank 15. KOD BANK

RHB Bank Maybank Bumiputra Commerce Public Bank Hong Leong Bank Hong Leong Finance Affin Bank EON Bank

01 02 03 04 05 06 07 08

Arab Malaysian Bank Alliance Bank Southern Bank Utama Bank Bank Muamalat Arab Malaysian Finance BanL Islam

09 10 11 12 13 14 15

16.

Nombor Akaun Bank Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah 16. NOMBOR AKAUN BANK
1

6 .

17.

Jejiis Akaun
I s i k a n )( m-- a k a u n vans. 1 lipihl n h 1 ( ) r|i m m s j a n \ a n e be i K> i> i n 17, ) E \ ' I S AKAUN in p u i'i i k i m a n p u tu infinilili Ak u r n Al W a d i a h Mia l u u d a k i 1

KONVFNSIONAL AI WADIAH

18,

Nama Pelaiar (Anak Ahlii

T u h s k a n n a m a anak t u a n / p u a n n a m a mengikut kad p e n g t n a l m M b a ^ a n n a n a >ang u n a t a t dalam kail p< ngenalan anak t u a n / p u a n lalah Muliamad bin Nounan, sila tuliskan aarna sepeiti di bawah Jika

1 8 . KAMA I I I AJAK (ANAK AUI I) M U H A M M A D I 1 \ \ O K M A N

19

Nombor Kad Pengenalan Pelajar

Isikan nombor Kad Pmfttiiilai Contoh 7 8 1 1 0 5 0 " ! <>li>f-> i ' d ^ n i n iK t u i n | i\d{]

19. N O M B O R KAD PEN(,I \/\) ^ 7 8 1 1 0 5 OS i)

I'l I V J A R 1 b ()

20.

Hubungan Ahli Dengan Pelaiar

l a n d a k a n h u b u n g a n ahli d i n t i n pi i|ai ( a i n k t m m p u a n di n i a n g a n \ a n g d i s c d i a k a n C o n t o h s e k i r a n v a h u b u n n a n i h l i d< i i " i n p c l a i a i i d i l a h i n a k k a n d u n g 20. HUBUNGA\ \N \K
v

M i l 1 1)1 \ ( , A N I I I A I \ R W \K \ \ ( . k \l

\ \ \ K ! <K\

21.

Naima Dan Cawangan Institusi Pengajian Tinggi

T u l i s k a n n a m a d a n c a w a n g a n intiiuM pcnj,a]ian tmggi C o n t o h iika n a m a m s t i t u s i pi nan<ui t m g ^ i t u a n / p u a n a t a u a n a k t u a n / p u a n m l a h isikan scperti di b a w a h 2 1 . NAMA DAN CAWANGAN IKSriTUSI PLNGAJIAN TINGGI l 1 Ml T s H A II A I A M

U i l M S h a h Alam

22.

Peringkat Pengajian
I n l i s k i n p e n n g k a t p t n g a i n n l u u i pu \n u a u a n a k m a n p u a n nioiigikul kod sepeiti di b a w a h 22. I]a/ah 1 Ija/ah I anpii in I F RINGKAI PI NGA.JIAN
;

l a m I n n ^ a I t c. S e t i n f

Diploma

i 4

23.

Lokasi Pengaiian Tuliskan lokasi pengajian tuan/puan atau anak tuan/puan mengikut kod seperti di bawah Dalam Negara
1

Lur Negara

24.

Nama Dan Cawangan Institusi Pemberi Piniaman (Jlka Ada) Tuliskan nama dan cawangan institusi pemberi pinjaman dengan lengkap 24. NAMA DAN CAWANGAN INSTITUSI PEMBERI PINJAMAN
M B| F P F I N N
A N C

E A Y

B A

E[T A L I

G|

|J

25.

Jenis Pengeluaran. Nombor Ahll. Nombor Kad Pengenalan Dan Cap Ibu Jari Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari klri dan kanan tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.

NAMA NO. AHLI

10. PERHATIAN 1 1 Sekiranya permohonan diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannya bagi tujuan pengesahan oleh Pegawai KWSP Sekiranya tuan/puan mengemukakan salinan dokumen sahaja, sila pastikan semua sahnan dokumen telah disahkan oleh pegawai yang dibenarkan oleh KWSP seperti berikut lengkap dengan nama dan cop rasmi pengesah (kecuali salinan dokumen-dokumen tertentu yang telah ditetapkan Pegawai Pengesahnya oleh KWSP):Pegawai KWSP yang terdiri danpada - Pegawai KWSP Gred 18 ke atas - Pegawai Kaunter KWSP 1 2 2 Majikan Pemohon 1 2 3 Penghulu atau Penggawa 124 Jaksa Pendamai 13 14 1 21 125 126 127 1 28 1 29 1210 Pengamal Perubatan yang berdaftar Penguambeladan Penguamcara Kumpulan Pengurusan/Profesional Kerajaan Ahli Dewan Undangan Negen Ahli Parlimen Pesuruhjaya Sumpah

TEL:(P)

(R).

12

Sekiranya permohonan bersama, sila sediakan 1 set dokumen bagi setiap permohonan Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam Tuan/puan hendaklah menurunkan cap ibu jan kin dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Jan berwarna hitam Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-bersama dengan permohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples) Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4 KWSP berhak menolak mana-mana permohonan yang tidak lengkap

15

16 17
2.0.

DOKUMEN UTAMA Tandakan (V) dalam kotak yang berkenaan 21 PENGELUARAN PENDIDIKAN AHLI 211 2 12 213 Borang permohonan KWSP 9H (AHL) - 2 salinan Borang KWSP 3A (AHL) -1 salinan Salman Kad Pengenalan ahli atau. Salman Kad Pohs/Tentera dan Surat Pengesahan Majikan menyatakan nombor Kad Pengenalan Awam dan Nombor Pohs/Tentera merujuk kepada orang yang sama, 21 4 Sekiranya pembayaran dibuat kepada ahli, sila kemukakan salinan muka hadapan Buku Akaun Bank yang mempunyai butir-butir akaun tuan/puan atau Penyata Akaun Semasa yang asal Pemohon hendaklah menurunkan cap ibu jan km dan kanan di atas salinan tersebut Sekiranya tuan/puan menghantar melalui pos, salinan dokumen hendaklah disahkan oleh Pegawai Bank berkenaan dan sek>fanya diserahkan di kaunter sila kemukakan dokumen asal beserta salinannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSP

2.1.5. Surat tawaran kemasukan ke Institusi Pengajian Tmggi (merujuk Tahun 1,2,3 dan seterusnya) (Sekiranya salman surat tawaran dikemukakan, hendaklah disahkan oleh Pegawai IPTyang diben kuasa atau Pegawai KWSP seperti di para 1.2.1) 2 1 6. Surat pengesahan yang mengesahkan jumlah yuran pengajian yang dikeluarkan oleh Institusi Pengajian Tmggi yang mengandungi butiran: (a) (b) (c) 2.2 Nama dan nombor kad pengenalan ahli Jems kursus di penngkat Diploma ke atas Tahun pengajian

PENGELUARAN PENDIDIKAN ANAK AHLI 2 2 1 . Borang dan dokumen seperti para 2 1 . 1 - 2 1 4 2.2 2. Salinan Kad Pengenalan Anak Ahli 2.2 3. Salman SIJII Kelahiran AnaK/Sijil Pengesahan Anak Angkat / (bukti pertahan bagi anak tin)
SIJII

Perkahwinan

2 2 4. Surat tawaran kemasukan ke Institusi Pengajian Tmggi (merujuk Tahun 1, 2,3 dan seterusnya) (Sekiranya salinan surat tawaran dikemukakan, hendaklah disahkan oleh Pegawai IPTyang diben kuasa atau Pegawai KWSP seperti di para 121) 2.2.5. Surat pengesahan yang mengesahkan yuran pengajian yang dikeluarkan oleh Institusi Pengajian Tmggi mengandungi butiran (a) Nama dan nombor kad pengenalan anak ahli (b) Jems kursus di penngkat yazah, yazah lanjutan atau yang setaraf dengannya untuk ahli di Institut Pengajian Tmggi yang berkenaan (c) Tahun pengajian 3.0. DOKUMEN TAMBAH AN 3.1 Pembayaran Kepada Institusi Pengajian Tmggi Dalam Negara Bagi Permohonan Ahli/Anak Dalam Tahun Pertama (i) Surat pengesahan pendaftaran danpada Institusi Pengajian Tmggi a) Nama dan nombor kad pengenalan ahli/anak ahli b) Jems kursus di penngkat Diploma ke atas untuk ahli dan di peringkat ijazah, ijazah lanjutan atau yang setaraf dengannya untuk anak ahli di Institusi Pengajian Tmggi yang berkenaan c) Tahun pengajian 3.2 Pembayaran Kepada Ahli Di Mana Ahli/Anak Ahli Mengikuti Pengajian Di Institusi Pengajian Tmggi Luar Negara

(i)
(n) 3.3.

Pasport
Visa pelajar (jika berkenaan)

Pembavaran Balik Kepada Ahli (i) Resit pembayaran yuran pengajian yang tidak melebihi 1 tahun dan tankh permohonan. (Sekiranya salinan resit pembayaran dikemukakan, hendaklah disahkan oleh Pegawai IPTyang diben kuasa atau Pegawai KWSP seperti di para 1 2.1)

23.

Lokasi Pengalian Tullskan lokasi pengajiP.n tuan/puan atau anak tuan/puan mengikut kod seperti dl bawah Dalam Negara
1

Lur Negara

24.

Nama Dan Cawangan Institusi Pemberi Pinjaman (Jika Ada) Tuliskan nama dan cawangan tnstltusi pemberi ptnjaman dengan lengkap : 24. NAMA DAN CAWANGAN INSTITUSI PEMBERI PINJAMAN M B F F I N A NI C[E B H D P E T A L I N G
J A Y A

ZULU I

25.

Jcnis Pengeluaran. Nombor Alili. Norabor Kad Pentfcnalan Pan Cap lbu Jari Isikan jenis pengeluaran, nombor anil, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.

KEGUNAAN KWSP SAHAJA

1 NOMBORAHLI

BUTIRAN A H L I 2 NOMBOR KADPENGENALAN12 DIGIT

I I II
3 HURUFAWALAN NAMAAHLI

IT

I1

I I I I
4 NOMBOR POLIS/TENTERA/PASPORT/DSB

NOMBORKADPENGENALAN7DIGIT

I I
5 KETURUNAN

II
r i i i i

ITI 1 I TTI I M T\

I I I I I I 1I I I I I

6 NAMAMENGIKUTKAD PENGENALAN/PASPORT

MOD PEMBAYARAN WARAN DRAFBANKASING ARAHANBAYARAN KREDITKE AKAUN BANK

FTTI
1 2 3 4
7 JANTINA LELAKI PEREMPUAN

PERBELANJAAN SEBENAR / ANGGARAN

JENIS AKAUN KONVENSIONAl AL WADIAH I PERBELANJAANPERUBATAN 9 KOS DIBIAYAIOLEH MAJIKAN RINGGIT MALAYSIA

1 2

RINGGIT MALAYSIA

SEN

SEN

I I I
1 AHLI 3ENDIRI

II
10 ORANG MENERIMA RAWATAN 4 IBU 5 BAPA 6 ANAK 7 ADIK BERADIK

I I

AMAUN OIBAYAR RINGGIT MALAYSIA

2 SUAMI

8 ORANG YANG DILULUSKAN OLEH LEMBAGA

SEN

3 ISTERI

II

I I I

11 NAM^ ORANG YANG MENERIMA RAWATAN (JIKA BUKAM AHLI SE NDIRI)

T
KODPENERIMABAYARAN AHLI PUSATPERUBATAN

I I I I

I I
I
\

T T I I I I I I
13 ALAMATAHLI

I I

1 2
12 NO KADPENGENALAN/SIJILKELAHIRANORANC YANG MENERIMA RAWATAN

I I I I I

I I
I I

I I I I I I I I I I I M

I I

I I
BANDAR

DISEMAKOLEH PEGAWAIPENYEMAK

POSKOD

IT IN
NEGFRI

I I I I I I I I I I I

CAW

UNIT

LL
I I

I I I I I I
14. NOMBOR TELEFONPEJABAT

i n
15 JENIS PEMBAYARAN WARAN DRAFBANKASING

i i i i

I
NO K/TGN

NOMBOR TELEFON RUMAH/BIMBIT

T I

ARAHANBAYARAN KREDITKE AKAUN BANK

I I I
TARIKH

I I

I
17 NOMBOR AKAUN BANK

BUTIRAN AKAUN BANK (SEKIRANYA PEMBAYARAN DIBUAT KEPADA AHLI)

16 KODBANK

JLU
18 JENIS AKAUN KONVENSIONAL AL WADIAH

I I I I I ITTT l i n

I TTI

I I

NOMBORAHU

EF T

NOKAOPENGENALAN

I I I I J U T I I J.

JEMSPENCELUARAN

BUTIR-BUTIR PESAKIT

NAMA SUAMI / ISTERI YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA (POTONG Dl MANA TIDAK BERKENAAN)

SILA NYATAKAN NAMA PENUH, NO KAD PENGENALAN DAN UMUR

NAMA MENGIKUT KAD PENGENALAN

NO KAD PENGENALAN

UMUR

in) IV)

NAMA ANAK-ANAK YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA, SILA NYATAKAN NAMA PENUH, JANTINA, NO KAD PENGENALAN DAN UMUR

NAMA MENGIKUT KAD PENGENALAN

JANTINA

NO KAD PENGENALAN

UMUR

in)

NAMA IBU / BAPA YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA, SILA NYATAKAN NAMA PENUH, JANTINA, NO KAD PENGENALAN DAN UMUR NAMA MENGIKUT KAD PENGENALAN JANTINA NO KAD PENGENALAN UMUR

NAMA ADIK-BERADIK YANG BERUMUR 16 TAHUN KEATAS YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA JANTINA, NO KAD PENGENALAN DAN UMUR

SILA NYATAKAN NAMA PENUH,

NAMA MENGIKUT KAD PENGENALAN

i)
II)

JANTINA

NO KAD PENGENALAN

UMUR

IV)

BUTIRAN HOSPITAL / INSTITUSI PERUBATAN / KESIHATAN

PEMBERITAHUAN DISAHKANOLEH: PEGAWAIPENGESAH

19. NAMA HOSPITAL / INSTITUSI PERUBATAN / KESIHATAN

i I II I I I Mill II
NO K/TGN

I I I I I I I I I I

I I I I I I

Mill
TARIKH

20. ALAMAT HOSPITAL /INSTITUSI PEflUBATAN / KESIHATAN

I I
POSKOD NEGERI

I I II I I I I I I I I I I I I I M M I II I I I II
BANDAR

I IIIII I I
i i ii

i i

LL
1.
DILULUSKANOLEH: PEGAWAIPELULUS1

111

I I I I II T

I I T IT I I I

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991. SAYA BERSETUJU SUPAYA JUMLAH KREDIT YANG DIKELUARKAN DARI AKAUN SAYA DIBAYAR TERUS KEPADA HOSPITAL/INSTITUSI PERUBATAN/KESIHATAN MENGIKUT JUMLAH DALAM BIL YANG OIPERSETUJUI OLEH SAYA (JIKA AHLI MENGGUNAKAN SURAT JAMINAN KWSP UNTUK MENERIMA RAWATAN)

21.
JENIS PENGELUARAN
NO K/TGN

NOMBOR AHLI

NOMBOR

1ARIKH

CAP IBU JARI KIRI DAN KANAN AHLI (MESTI DITURUNKAN DENGAN TERANG DAN PENUH MENGGUNAKAN PAD CAP IBU JARI BERWARNA HITAM)

KIRI

KANAN

TARIKHPEGAWAIPELULUS2

NO K/TGN

I I I I I
TARIKH

PANDUAN UNTUK MENGISI BORANG KWSP 9D (AHL) PEMBERITAHUAN PENGELUARAN KESIHATAN

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAH DIPENUHIDENGAN HURUF BESAR.

1.

Nombor Ahll

Isikan satu digit di setiap ruang dengan didahului oleh digit '0' jiKa perlu, seperti contoh di bawah Contoh : 1234567 1. NOMBOR AHLI 0 1

Nombot Kad Pengenalan 12 Digit Isikan nombor Kad Pengenalan 12 digit tuan/puan. 12 digit, kosongkan ruangan ini : Contoh : 610701-02-6157 2. NOMBOR KAD PENGENALAN 12 DIGIT Jika tuan/puan belum memilikl Kad Pengenalan

Nombor Kad Pengenalan 7 Digit Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah : 3. NOMBOR KAD PENGENALAN 7 DIGIT
a)
b)

1234567 A 1234567 K 1234567 H 1234567

c)
d)

4.

Nombor Polls/Tentera/Pasport/Dsb Isikan Nombor Kad Pengenalan Polls/Tentera/Pasport/Dsb termasuk huruf awalan, seperti contoh di bawah 4. NOMBOR POLIS/TENTERA/PASPORT/DSB 4 5 6 7 2 3
2 3

a) b)

1234567

T 1234567

" 4~1 5 "

5.

Ketnrunan

Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, isikan seperti di bawah : 5. KETURUNAN [ 1

Melayu Cina India Lain-lain

1 2 3 4

Bidayuh Kadazan Iban

5 6 7

6.

Nama Mengikut Kad Pengenalan/Pasport Tuliskan nama tuan/puan sebagaimana yang tercatat delam kad pengenalan tuan/puan. Jlka nama mengikut kad pengenalan ialah Norman bin Abdullah, sila tuliskan nama seperti di bawah : 6. _NAMA MENGIKUT KAD PENGENALAN/PASPORT r N B I I N A B D U ! L

N O R

1JL
7. Jantina Tandakan jantina tuan/puan dengan K) dalam ruang yang disediakan yang berkenaan seperti di bawah 7. JANTINA LELAKI PEREMPUAN Perbelanjaan Perubatan Sebenar/anggaran ialah bil perubatan yang telah atau akan dikenakan oleh pusat rawatan yang diktiraf. Kos rawatan akan dikenakan oleh pusat rawatan yang diiktiraf. Jika kos rawatan yang dikenakan untuk penyakit kanser ialah RM 10.000 00, isikan seperti di bawah 8. PERBELANJAAN PERUBATAN RINGGIT MALAYSIA
0 0
1

Jika lelaki, tandakan K ) di ruang

SEN 0 0 0

9.

Kos Yang Dibiavai Oleh Maiikan Kos rawatan yang dibiayai oleh majikan. Contohnya Kos rawatan pesakit (isteri) RM 10,000.00 Biayai majikan: RM 4,000.00 Isikan seperti berikut . 9. KOS YANG DIBIAYAI OLEH MAJIKAN SEN RINGGIT MALAYSIA 0 0 0 4 0 0 0 0 0

10.

Orang Yang Menerima Rawatan Tandakan hubungan pesakit dengan pemohon di ruangan berkenaan Contoh: Pesakit ibu, tandakan ( ^ ) 10. ORANG YANG MENERIMA RAWATAN 1. AHLI SENDIRI 2. SUAMI 3. ISTERI 4 IBU 5 BAPA 6. ANAK 7. ADIK-BERADIK 8. ORANG YANG DILULUSKAN OLEH LEMBAGA

Nama Orang Menerima Rawatan (Jika bukaa ahli sendiri) Jika orang yang menerima rawatan adalah ibu tuan/puan, isikan nama ibu tuan/puan di dalam petak-petak yang berkenaan. Jika nama ibu t u a n / p u a n adalah Julia bte Ahmad, tuliskan seperti di bawah :
1 1 . NAMA ORANG MENERIMA RAWATAN (JIKA BUKAN \HL1 SENDIRI) J

12.

No. Kad Pengenalan/ Sijlll Kelahiran Orang vang Menerima Rawatan Islkan No. Kad Pengenalan orang yang menerlma rawatan. Contohnya, jlka No. Kad Pengenalan ibu tuan/ puan ialah 450903 - 01 - 2346, tullskan sepertl dl bawah : 12. NO. KAD PENGENALAN/ SIJIL KELAHIRAN ORANG YANG MENERIMA RAWATAN
0 0

13.

Alamat Ahli Tullskan alamat surat menyurat tuan/puan dengan lengkap. Jlka alamat surat menyurat tuan/puan adalah Lot 10, Kg Pant Kadlr Tlmur, Buklt Paslr, 84300 Muar, Johor Darul Takzlm, slla penuhl sepertl berlkut
13. ALAMAT AHLI I T P A R
I

O
T

1 U

0 B

K
U

A
I

POSKOD
8 4 3

BANDAR 0
0 M U A

NEGER1
J O H

A. 1 R

14.

Nombor Telefon Islkan nombor telefon dl ruangan yang dlsedlakan dl bawah : Contoh : Nombor Telefon Pejabat : 07 - 9859450 14. NOMBOR TELEFON PEJABAT
8 0

dan

Nombor Telefon Rumah/Blmbit : 016 - 2070158

NOMBOR TELEFON RUMAH/BIMBIT 2 0 7 10 1 5 8

IS.

Jenis Pembavaran
Jika t u a n / p u a n memilih kaedah pembayaran kredit ke akaun bank, tanda K ) dl ruang yang berkenaan sepertl dl bawah ;
I S . JENIS PEMBAYARAN

WARAN DRAF BANK ASING

ARAHAN BAYARAN KREDIT KE AKAUN BANK

1'

16.

Kod Bank Isikan nombor kod bank dl ruangan yang disediakan seperti di bawah Jlka kod bank tuan/puan adalah Maybank 16. KOD BANK

RHB Bank Maybank Bumiputra Commerce Public Bank Hong Leong Bank Hong Leong Finance Affin Bank EON Bank

01 02 03 04 05 06 07 08

Arab Malaysian Bank Alliance Bank Southern Bank Utama Bank Bank Muamalat Arab Malaysian Finance Bank Islam

09 10 11 12 03 13 14

17,

Nombor Akaun Bank Jika nombor akaun bank adalah 1-23456 -789012-3, islkan ruangan berkenaan sepertt di bawah : 17. NOMBOR AKAUN BANK
1

3 I9 | 0

18.

Jenip Akaun
Jika akaun tuan/puan adalali jenis konvensional, tanda ( / ) di ruang yang berkenaan sepcrti di bawah 18. JENIS AKAUN KONVENSIONAL AL-WADIAH

19.

Nama Hospital/Institusi Perubatan/Kesihatan

Jika tuan/puan/pesakit mendapat rawatan daripada Pusat Pakar Utara Sdn. Bhd., sila tuliskan seperti di bawah :
19. NAMA HOSPITAL INSTITUSI PERUBATAN/KESIHATAN P A K A R A A T A1 R U T
B H D

u
D

S N

20.

Alamat Hospital/Institusi Perubatan/Kesihatan Jika alamat hospital berkenaan adalah No. 21, Jalan 11/2, 40000 Shah Alam, Selangor Darul Ehsan, Tuliskan seperti di bawah : 20. ALAMAT HOSPITAL/INSTITUSI PERUBATAN/KESIHATAN
N 0

POSKOD
4 0 0 0 0

BANDAR
S H A H A L A M

NEGERI
S

21.

Jenis Pengeluaran. Nombor Ahli. Npmbor Kad Pengenalan Dan Cap Ibu Jar! Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hltam.

NAMA

: TEL:(P) (R).

NO. AHLI :

1.0

PERHATIAN 1.1 Sekiranya permohonan diserahkan di kaunter KWSP, sila kemukakan dokumen asal beserta salinannya untuktujuan pengesahan oleh Pegawai KWSP. Sekiranya tuan/puan mengemukakan salinan dokumen sahaja, sila pastikan semua salinan dokumen telah disahkan oleh pegawai yang dibenarkan oleh KWSP seperti berikut lengkap dengan nama dan cop rasmi pengesah (kecuali salinan dokumen-dokumen tertentu yang telah ditetapkan Pegawai Pengesahnya oleh KWSP): 1.2.1. Pegawai KWSP yang terdiri daripada - Pegawai KWSP Gred 18 keatas - Pegawai Kaunter KWSP 1.2.2. Majikan Pemohon 1.2.3. Penghulu atau Penggawa 1.2.4. JaksaPendamai 1.3 1.4 1.2.5. 1.2.6. 1.2.7. 1.2.8. 1.2.9. 1.2.10. Pengamal Perubatan yang berdaftar Peguambela dan Peguamcara Kumpulan Pengurusan/Profesional Kerajaan Ahh Dewan Undangan Negeri Ahli Parlimen Pesuruhjaya Sumpah

1.2

Sekiranya permohonan bersama, sila sediakan I set dokumen bagi setiap permohonan. Setiap borang permohonan hendaKlah ditulis dengan pena dakwat berwarna hitam. Tuan/puan hendaklah menurunkan cap ibu jari kiri dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwama hitam. Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-sama dengan borang permohanan DIKLIPKAN dan tidak menggunakan dawai kokot (staples). Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4. KWSP berhak menolak mana-mana permohonan yang tidak lengkap.

1.5

1.6 1.7

2.0

DOKUMEN UTAMA Tandakan ( V ) dalam kotak yang berkenaan 2.1 2.2 2.3 Borang Permohonan KWSP 9D (AHL) - 2 salinan Borang KWSP 3A (AHL) -1 salinan Salinan Kad Pengenalan ahli, ateu Salinan Kad Pengenalan Poiis/Tentera dan Surat Pengesahan Majikan menyatakan Nombor Kad Pengenalan Awam dan nombor Polis/Tentera merujuk kepada orang yang sama. | [ I | I | |

2.4

Salinan muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan slau Penyata Akaun Bank Semasa yang asa! Pemohon hendaklah menurunkan cap ibu jari kiri dan kanan di atas salinan tersebut. Sekiranya tuan/puan manghantar melalui pos, salinan dokumen hendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSP. Laporan Perubatan yang tidak melebihi satu tahun yang mengandungi: (a) (b) (c) (d) (e) (f) Butiran Pesakit Keadaan Kesihatan semasa Pesakit Tankh Laporan Nama Pusat Perubatan Nama dan Cop Rasmi Doktor Tandatangan Doktor | [

2.5

(Sekiranya salinan Laporan Perubatan dikemukakan, hendaklah disahkan oleh Doktor/Hospital berkenaan atau Pegawai KWSP seperti di para 121) 2.6 Surat pengesahan dan maiikan samada kos rawatan dibiayai oleh majikan atau tidak (Sekiranya pesakit adalah anak pengesahan majikan ibu dan bapa diperlukan dan sekiranya pesakit bekerja, surat pengesahan majikan pesakit juga diperlukan Bagi pesakit Dasangan suami isten, pengesahan majikan pesakit dan pasangan diperlukan) 27 Bil dan resit bayaran dan pusat perubatan yang tidak melebihi satu tahun dan tankh permohonan (jika bayaran telah dibuat) ATAU Anggaran kos rawatan dan pusat perubatan atau pakar bagi rawatan yang dilakukan bagi ahli yang memerlukan surat jaminan KWSP untuk mendapatkan rawatan (Sekiranya salinan bil/resit bayaran/anggaran kos rawatan dikemukakan, hendaklah disahkan oleh Doktor/Hospital berkenaan atau Pegawai KWSP seperti di para 1.2.1) 2.8 Bukti pertahan di antara ahli dan pesakit. (Jika pemohon bukan pesakit) | | [__

Tandatangan Ahli

Tankh Tankh

Tandatangan Penenma :

KUMPULAN WANG SIMPANAN PEKERJA 1 OGOS 2001

KWSP9C (AML) PERCUMA

AKTA KUMPULAN WANG SIMPANAN PEKERJA1991 PEMBERITAHUAN PENGELUARAN MEMSEU / MEMBINA RUMAH ATAU MENGURANGKAN / MENYELESAIKAN PINJAMAN PERHATIAN MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATA'J TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEMBERIKAN APA-APA DOKUMEN PALSU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MELAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BOLEH DIDENDA ATAU DIPENJARA ATAU KEDUA-DUANYA

KEGUNAAN KWSP SAHAJA

JENIS PFNGELUARAN YANG DIPOHON SILA TANDAKAN I -J) PI KOTAK YANG BERKENAAN 1 JENIS PENGaUARAN PERTAMA KEDUA

1 KP 2 3
HURUF AWALAN NAMA AHLI 2 NOMBORAHLI

MEMBai / MEMBINA RUMAH MENGURANGKAN / MENYaESAIKAN PINJAMAN MENGURANGKAN / MENYaESAIKAN PINJAMAN PASANGAN

BUTIRANAHU
3. NOMBOR KAD PENGENALAN 12 DIGIT

4 NO KAD PENGENALAN 70IGIT/POUS/TENTERA/PASPORT/DSB MOD PEMBAYARAN WARAN DRAF BANK ASING ARAHAN BAYARAN KREDITKEAKAUNBANK

5 TARIKH SURATPERJANJIAN JUAL BELI

6 KETURUNAN

1 2 3 4
7 NAMA MENGIKUT KAD PENGENALAN/PASPORT JANTINA 1ELAKI PEREMPUAN

1
9 HARGA BaiAN / KOS PEMBINAAN 10 JUMAH PINJAMAN / BAKI PINJAMAN
RINGGIT MALAYSIA RINGGIT MALAYSIA

KOD PINJAMAN AHLI PASANGAN 11 SEKTOR PEKERJAAN BEKERJASENDIRI KERAJAAN JENIS AKAUN KONVENSIONAL ALWADIAH SWASTA

SEN

SEN

12 BUTIRANHARTA NO LOT/PT NO HS(M/D) NO PARCEL FLAT/APP/ KONDOMINIUM

1 2

TIDAK BEKERJA

13 ALAMAT HARTA
DISEMAKOLEH PEGAWAI PENYEMAK | POSKOO BANDAR

NEGERI

14 ALAMAT AHLI

CAW

UNfT

I
POSKOD NEGERI

T
BANDAf

I I

NOK/TGN

TARIKH

15 NOMBOR TaEFON (PEJABAT)

WARAN NOMBOR TaEFON (RUMAH)
i

16 JENIS PEMBAYARAN ARAHAN BAYARAN KREDITKEAKAUNBANK

DRAF BANK ASING

BUTIRAN BANK
17 KOD BANK 18 NOMBOR AKAUN BANK (Hanya untuk membei/membma mmah)

I I
20 NOMBOR AKAUN PINJAMAN PERUMAHAN (Hanya untuk mengurang/menyetesakan pin|amanj

19 JENIS AKAUN KONVENSIONAL AL-WADIAH

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991 PEMBERITAHUAN PENGELUARAN 50 TAHUN/55 TAHUN/DIVIDEN/KETIDAKUPAYAAN

KWSP98(AHL) PERCUMA

PERHATIAN MANAMAM ORAN& YANG MEMBUAT W APA KENYA MAN U N G TIDAK BETUL \TAU TIDAK BENAP A I A U M NGFMUKAKAN ATAU MEMBERiKAN APAAPA DOKUVLN PAISL JALAM A H A / O A BUTIRBUTIR MUSTAhAK ADALAH MELAKJKAN KfcSALAHAN DAN AKAN MENYE8ABKAN ) RlNYA BOLEH DIDENDA ATAU DIPENJARA ATAU KEDUA DUANYA

KEGUNAAN KWSP SAHAJA KP

l KJRLFAWALAN \|AKA AHL

SILATANOAKAN (V) Dl KOTAKYANGBERKbNAAN 1 JENIS PtNGELLARAN 50 TAHUN DI/IDEN

r

i5 TAHUN 1 KE [IDAKUPAYAAN
'

L"X_"
MOD PFMBAYARAN /VARAN DRAFBANKASING \RAHAN BAYARAN KREDIT KEAKAl IN BANK

LNTUK PENGELUARAN 55TAHUN FKIRANYA AHLI MASIH BEKERJA DAN NGIN IfcRUS \FNCARUM TANDAKAN (V) Dl RUANGAN BERKENAAN NblN TERUS MENCARUM YA ( ) "IDAK ( ) JIKA M bILA ISIKAN BORANG KWSP 20 (AHL) DAN KWSP ?0A AriL) i iiiTiii/ nc^rrtCi I I A D I U DCUIIU UNTUK PENGELUARAN PENUH TIDAK ( ADA PEMINDAHAN PELABURAN YA (

BUTIRANAHIl

2 NOMBOR AHII

1 I OMBOR KAD PENGENALAN 12 DIGIT

4 __JENISAKAUN KONVENSIONAL Al WADIAH STATUS AKAJNAHU

NOMBOR KAD PENC EN \LAN 7 DIGIT

nzz
8 TARIKH LAHIR

6 NAMA MENGIKUT KAD PENGENALAN/PASPARr

nrrnm nnznznn: nxizn

_L I
9 JANTINA

NOMBfR POMS TENTERA/PASPORT/DSB

7 KETURUNAN

TJ

10 SEKTOR PEKERJAAN

h
I Pt.NE.RiVK BAY/"AN
t. _

LEuAKI PEREMPUAN

AHL! 11 ALAMATAHU

UISEMAK OLEH PFGAWAI PFNYFMAK PJ&KOD BANDAR

AW

NIT

NEGfcRI

i n u i in iTxrn:
13 JENIS PEMBAYARAN WARAN N ARAHAN BAYARAN KREDIT KEAKAUN BANK BANK \SING

I r
1 \RIKH

NO KTCN

12 NOMBOR TELEFON PEJABAT

JZLT:
DISAHKANOLEH PLGAWAI PENGESAH

njznjrr
14 KOOBANK

NOMBOR TbLEFON RUMAH/BIMBIT

BUTIRAN AKAUN BANK

16 JENIS_AKAUN 11) N MBOR AKAUN BANK C

nn
T ""I
NOVRO'< Wf

KONVENSIONAL nL WAOIAt

NO KTGN

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Di KWSP MENURUT PERUNTUKAN AKTA KWSP 1991

~T~T L_
ARKH

17
JENIS PENIGtLUARAN

DILULoSKAN OLtH PECAWM PELJLUS 1

NOMBOKAHU

j'
MNAH

LJ

K1SJ
CAP Bt i R K R ( AN KANANAHLI (MESTI DITJKUNKAN DtNOAN TrRAMGDANPENJH

NO J.
ARKH PEGAWAI PELULUS 2

CAMBUJARIBf-RW RNA H AM) 1ARIKI-

NO K/TGN

L.

TARIKH

KUMPULAN WANG SIMPANAN PEKERJA

SENARAISEMAKAN SKIM PENGELUARAN PERSARAAN 50 TAHUN/55 TAHUN/DIVIDEN NAMA NO.AHL! 1.0 : : ,. , TEL: (P) , (R)

PERHATIAN 1.1. 1.2. Sekiranya permohonan diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannya bagi tujuan pengesahan oleh Pegawai KWSP. Sekiranya tuan/puan mengemukakan salinan dckumen sahaja, sila pastikan semua salinan telah disahkan oleh pegawai yang dibenarkan oleh KWSP seperti bcrikut lengkap dengan nama dan cop rasmi pengesah : 1.2.1. 1.2.2 1.2.3 1.2.4 1.2.5 1.3. Pegawai KWSP yang terdiri daripada - Pegawai KWSP Gred 18 keatas Pegawai Kaunter KWSP Majikan Pemohon Penghulu atau Penggawa Jaksa Pendamai Pengamal Perubatan yang berdaftar Peguambela dan Peguamcara Kumpulan Pengurusan/Profesional Kerajaan 1.2.8. Ahli Dewan Undangan Negeri 1.2.9. Ahli Parlimen 1.2.10. Pesuruhjaya Sumpah 1.2.6. 1.2.7.

Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam. Tuan/puan hendaklah menurunkan cap ibu jari kin dar kanan dengan terang dan penuh menggunakan Pad Cap ibu Jari berwarna hitam. Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-sama dengan borang permohonan DIKUPKAN dan tidak menggunakan dawai kokot (staples). Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4. KWSP berhak menolak mana-mana permohonan yang tidak lengkap.

1.4. 1.5. 1.6. 2.0

DOKUMEN UTAMA Tandakan (V) dalam kotak yang berkenaan. 2.1. 2.2. 2.3. Borang permohonan KWSP 9B(AHL) - 2 salinan Borang KWSP 3A (AHL) - 1 salinan Salinan Kad Pengenalan Salinan Kad Pengenalan Polis/Tentera dan Surat Pengesahan Majikan menyatakan No. Polis/Tentera dan No. Kad Pengenalan merujuk kepada orang yang sama

24

Salinan pasport bagi warganegara aslng (Sila kemukakan salinan pasport yang lama sekiranya nombor pasport terkini berbeza dengan rekod KWSP) Salinan muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan atau Penyata Akaun Bank Semasa yang asal. Pemohon hendaklah menurunkan cap ibu jari kin dan kanan di atas salinan tersebut. Sekiranya tuan/puan menghantar melalui pos, salinan dokumen hendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSP

25

3.0

DQKUMEN TAMBAHAN 31 Sijil Kerakyatan/Syil Kelahiran (jika No Kad Pengenalan tiada dalam rekod KWSP)

Tandatangan Ahli Tandatangan Penerima :

Tarikh Tarikh

KUMPULAN WANG SIMPANAN PEKER.JA 1 OGOS 2001

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991 PEMBERITAHUAN PENGELUARAN 50 TAHUN/55 TAHUN/DIVIDEN/KETIDAKUPAYAAN

KWSP 9B (AHL) PERCUMA

PERHATIAN : MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATAU TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEMBERIKAN APA-APA DOKUMEN PAl.SU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MF.LAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BO1.EH DIDENDA ATAU DIPENJARA ATAU KEDUA-DUANYA

KEGUNAAN KWSP SAHAJA

SILATANDAKAN (V) Dl KOTAK YANG BERKENAAN 1. JEMS PENGELUARAN

1 3

50 TAHUN DIVIDEN

2 | 55TAHUN 4 I KETIDAKUPAYAAN I

UNTUKPENGELUARAN55TAHUN: SEKIRANYA AHLI MASIH BEKERJA DAN INGIN TERUS MENCARUM, TANDAKAN (V) Dl RUANGAN BERKENAAN INGIN TERUS MENCARUM YA ( ) TIDAK { j . JIKAYA, SILA ISiKAN BORANG KWSP 20 {AHL) DAN KWSP 20A [AHL) UNTUK PENGELUARAN PENUH : ADAPEMINDAHAN PELABURAN. YA( } TIDAK', )

j |

i | I

BUTIRAN AHLI
2. NOMBOR AHLI 3. NOMBOR KAD PENGENALAN 12 DIGIT

KREDIT KE AKAUN BANK JENISAKAUN KONVENSIONAL AL-WADIAH 1 2

J
4. NOMBOR KAD PENGENALAN 7 DIGIT

LJL

r r

EEUD

5. NOMBOR POUS/TENTERA/PASPORT/DSB

__

STATUS AKAUN AHLI AKTIF TUTUP (UNTUK PENGELUARAN D2-5) PENERIMA BAYARAN AHLI PENJAGA (UNTUK PENGELUARAN D2-6) OISEHAKOLEH : Pf.GAWAIPENYEMAK

imnmu-immrnm
cmnmujjjjjjjmnmni]
8. TARIKri LAHIR 9. JANTINA

6. NAMA MENGIKUT KAD PENGENALAN/PASPORT

7. KETURUNAN

SWASTA TIDAK BEKERJA

10. SEKTOR PEKERJAAN BEKERJA SENDIRI KERAJAAN

LELAKI PEREMPUAN
11. ALAMATAHLI

mm:
r r Hi..

rm
TUT

~T
i|

mi

mr
CW A
UNIT NEGERI

POSKOD

BANDAR

in
13. JENIS PEMBAYARAN WARAN ORAF BANK ASING ARAHAN BAYARAN KREDIT KE AKAUN BANK

n
BUTIRAN AKAUN BANK
16. JENISAKAUN

NO. K/TGN

12. NOMBOR TELEFON PEJABAT

IIL:
TARIKH :... OISAHKANOLEH : PEGAWAIPENGESAH

D"

NOMBOR FELEFON RUMAH/BIMBIT

IZLTTTEEITT]
14. KOD BANK i5. NOMBOR AKAUN BANK

XD
17.
TARIKH DILULUSKAN OLEH : PEGAWAI PELULUS1 JENIS PENGELUARAN

nmmm
NOMBOR K/P

KONVENSIONAL AL-WADIAH

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991.

NOMBOR AHLI

KIRI
CAP IBU JARI KIRI DAN KANAN AHLI (MESTI DITURUNKAN DENGAN TERANG DAN PENUH MENGGUNAKANPAD CAP IBU JARI BERWARNA HITAM) TARIKH :

KANAN

TARIKH PEGAWAI PELULUS 2

NO. K/TGN

LIITTIIIJ
TARIKH :

PANDUAN UNTUK MENGIS! BORANG KWSP 9B (AHL) PEMBERITAHUAN PENGELUARAN 50 TAHUN / 55 TAHUN / DIVIDEN / KETIDAKUPAYAAN
SILA BACA PANDUAN INI DENGAN TELITI SFBELUM MENGISI BORANG. BORANG PERMQHQNAN MESTILAH DIPENUHKAN DENGAN HURUF BESAR.

1.

Jenis Pengeluaran Siia tanda (V) dalam petak yang berkenaan Jika tuan/puan memohon pengeluaran 50 Tahun, tandakan (V) seperti di bawah

1. JENIS PENGELUARAN

50 TAHUN

55 TAHUN KETIDAKUPAYAAN

i_3_
Untuk Pengeluaran 55 Tahun

DIVIDEN

Sekiranya ahli masih bekerja dan mgin terus mencaoim, sila tandakan (V) di ruangan yang berkenaan. INGIN TERUS MENCARUM Untuk Pengeluaran Penuh ADA PEMlNDAHAN PELABURAN, YA ( V ) TIDAK ( ) ( V ) YA ( ) TIDAK

Nombpr Ahli Isikan satu digit di setiao ruang dengan didahului oleh digit '0' jika perlu, seperti contoh di bawah: Contoh : 1234567 2. NOMBORAHLI 0 1 2

3.

Nombor Kad Pengenalan 12 Digit Ahli Isikan nombor Kad Pengenalan 12 digit tuan/puan Jika tuan/puan belum memiliki Kad Pengenalan 12 digit, kosongkan ruangan ini: Contoh : 460701-02-6157

3. NOMBOR KAD PENGENALAN 12 DIGIT 0

Nombor Kad Pengenalan 7 Digit Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah 4. NOMBOR KAD PENGENALAN 7 DIGIT

a)

1234567

b)

A 1234567

L7 .LL

g ^

c)
d)

K1234567
H1234567

5.

Nombor Polis/Tentera/Pasport/Dsb Isikan Nombor Polis/Tentera/Pasport/Dsb, seperti contoh di bawah : 5. NOMLOR POLISffENTERA/PASPORT/DSB a) I 1234567 '

1
1 2 3 5

b)

T 1234567

Nama Mengikut Kad Pengenalan/Pasport Tuliskan nama tuan/puan sebagaimana yang tercatat dalam kad pengenalan. Jika nama mengikut kad pengenalan ialah Norman bin Abdullah, sila tuliskan nama seperti di bawah;

6. NAMA MENGIKUT KAD PENGENALAN/PASPORT N 0 R M A N B JJ N A B D U L L A H

i

Keturunan Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, isikan seperti di bawah: 7. KETURUNAN

1 1 2 3 4
Bidayuh Kadazan Iban

Melayu Cina India Lain-lain

Tarikh Lahir Isikan tarikh lahir tuan/puan mengikut susunan hari, bulan dan tahun. Jika tarikh lahii tuan/puan pada 1 Julai 1946, isikan seperti di bawah: 8. TARIKH LAHIR

H 0

H 1

B 0

B 7

T 4

T 6

Jantina
Tandakan jantina tuan/puan dengan (S) dalam ruang yang disediakan. Jika lelaki, tandakan ( V ) di ruang yang berkenaan seperti di bawah: 9. JANTINA LELAKI PEREMPUAN

10.

Sektor Pekeriaan Tandakan (</) dalam ruang yang disediakan. Jika tuan/puan bekerja dalam sektor swasta, tanda (S) dalam ruang yang berkenaan seperti di bawah: 10. SEKTOR PEKERJAAN BEKERJA SENDIRI KERAJAAN SWASTA TIDAK BEKERJA

11.

Alamat Ahli Tuliskan alamat surat menyurat tuan/puan dengan lengkap. Jika alamat surat menyurat tuan/puan adalah Lot 10, Kg Parrt Kadir Timur Bukit Pasir, 84300 Muar, Johor Darul Takzim, sila penuhi seperti berikut:

11. ALAMAT AHLI

O I

T M U

"of
I

TK
I

G K 1

R P

I
1

|T

R I ] BI U
BANDAR

POSKOD

I' I'
12.

NEGERI

Nombor Telefon Isikan nombor telefon di ruangan yang disediakan di bawah. Contoh : Nombor Telefon Pejabat: 07-9859450 dan Nombor Telefon Rumah/Bi.-nbit 12. NOMBOR TELEFON PEJABAT

016-2070158

sT7T4

NOMBOR TtLEFON RUMAH/BiWBIT

lil
13.

? J 0 |7 [0

|.

Jenis Pembavaran Jika tuan/puan memilih cara pembayaran kredit ke akaun bank, tanda (S) di ruang yang berkenaan seperti di bawah . 13. JENIS PEMBAYARAN WARAN

DRAFBANKASING

LARAHAN BAYARAN I KREDIT KE AKAUN BANK

14.

KodJank isikan nombor kod bank di ruangan yang disediakan seperti di bawah Jika kod bank tuan/puan adalah Maybank

rz

14. KOD BANK

RHB Bank Maybank Bumiputra Commerce Public Bank Hong Leong Bank Hong Leong Finance Affin Bank EON Bank 15. Nombor Akaun Bank

01 02 03 04 05 06 07 08

Arab Malaysian Bank Alliance Bank Southern Bank Utama Bank Bank Muamalat Arab Malaysian Finance Bank Islam

09 10 11 12 13 14 15

Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah 15. NOMBOR AKAUN BANK
1 2 3 4 5 6 7 8 9 0 1 2 3

16.

Jenis Akaqn Jika akaun tuan/puan adalah jenis konvpnsional, tanda (*Q di ruang yang berkenaan seperti di bawah 16. JENIS AKAUN KONVENSIONAL AL-WADIAH

17.

Jenis Pengeluaran, Nombor Ahli. Nombor Kad Pengenalan dan Cap Ibu Jari Isikan jenis pengeluaran, nombor ahl' dan nombor kad pengenalan serta turunkan cap ibu jari kin dan kanan tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam

KUMPULAN WANG SIMPANAN PEKERJA EMPLOYEES PROVIDENT FUND

SENARAI SEMAKAN SKIM PENGELUARAN MENINGGALKAN NEGARA LEAVING COUNTRY WITHDRAWAL CHECKLIST
Nama Ahli Member's Name No Ahli Member's No No Pasport Passport No Tel (P) Tel(O) (R) (R)

10

PENTING IMPORTANT 1 1 Sekiranya permohonan diserahkan di kaunter KWSP sila kemukakan clokumen asal beserta salmannya untuk tujuan pengesahan oleh Pegawai KWSP When submitting the application form at the counter please produce ongmal documen's together with the photostate copies of the document for the purpose of certification by EPF officers bekiranya tuan/puan mengemukakan salinan dokumen sahaja sila pastikan semua saiman dokumen telah disahkan oieh majikan tuan/puan dtau pegawai yang dibenarkan oleh KWSP seperti benkul lengkap dengan nama d a i cop rasmi pengesah When submitting photostate documents please ensure that photostate copies of all the documents are certified true copy by vcur e 7)o/o> er or authorized officers as follows complete with the name and official stamp of the officer concerned 1 21 Pegawai KWSP EPF Officer Pegawai KWSP (Gred 18 ke ata) EPF Officer (Grade 18 and Above) ' Pegawai Kaunter KWSP EPF Counter Officer 122 Pegawai Kedutaan Malaysia Malaysian Embassy Officer Notan Awam Public Notary

" ?

' 23

13

Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwdrna hjldDl Tuan/puan hendaklah menurunkan cap bu jan kin dan xanan de^iqan terang dan penuh menggunakan Pad Cap Ibu Jan bciyvarna hjtam. Ldch withdrawal form must be completed using bjsoi ink pa Members must a/so affix higher nght and left thumbpnnt cleiriy and in lull using black ink thumbpnnt psd Tuan/puan henolakldh rr^mastikdn dokumen dokunen yang disertakan beibama sama dengan borang oermohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples) Please ensure that all documents forwarded togethei with the apulicatior form are CLIPPER md not stappled

14

15

Semua salinan fotostat dokumen hendaklah me iggunakin kertas saiz A4 All photostate cop'es of documents must be on A4 sue papr KWSP berhak menolak mana manu permohoPcn yang idak lengkap EPF reserves the ngh1 to 'eject incomplete application

16

20

DOKUMEN UTAMA MAIN DOCUMENTS Tandakan (V) dalam kotak yang berkenaan Please tick (V) in the box where applicable 21 22 Borang Permohonan KWSP 9B (AHL) - 2 salinan Borang KWSP 3A (AHL) - 1 salinan Form KWSP 3A (AHL.) -1 copy Salman muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan atau Penyata Akaun Bank Semasa yang asal Pemohon hendaklah menurunkan cap ibu jan kin dan kanan di atas salinan tersebut Sekiranya tuan/puan menghantar melalui pos, salinan dokumen hendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, sila kemukakan dokumen asal beserta sahnannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSP Photostate copy of the front page of your bank book with details of your bank account number ox the original copy of your current Account Bank Statement Applicants are required to affix left and right thumb print impression on copies of the document Please forward the ongmal document together with a photostate copy to be certified by the EPF Counter Officers at the counter Photostate copy of the bank book mus< be cenified true copy by the respective bank's officer if submission ii through post

23

3.0

PEGAWAI DAGANG EXPATRIATE 31 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport (Sila serahkan salinan pasport yang lama sekiranya nombor pasport terkini berbeza denqan rekod KWSP) Photostate copy of valid passport stating clearly your name and passport number (Please forward photostate copy of old passport if current passport number differs from EPF records) Bukti penamatan kerja Proof of resignation/tenmnption of contract - Surat penamatan kontrak oleh majikan Acceptance of resignation/termination of contract by employer ATAU OR - Penyata Perlepasan Cukai Pendapatan Income tax clearance lefer 33 Pembatalan permit kerja (Tidak malebihi 3 bulan dan tankh permohonan) Cancellation of work permit (Not exceeding 3 months from the date of application) Sila bekalkan alamat ahli di luar negara Please give your overseas correspondence address

32

34

4.0

BEKAS WARGANEGARA MALAYSIA rAYSIAN CITIZEN 4 1 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport Photostate copy of valid passport stating clearly your name and passport number Surat Penyerahan Kad Pengenalan dan Pelucutan Kewarganegaraan danpada Pejabat Pendaftaran Negara Letter of surrendenng of the Identity Card and renounciation of citizenship from the Registration Office Sila bekalkan alamat ahli di luar negara Please give your overseas correspondence address

42

43

50

PEKERJA ASING FOREIGN WORKER 51 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport (Sila kemukakan salinan pasport yang lama sekiranya nombor pasport terkini berbeza dengan rekod KWSP) Photostate copy of valid passport stating clearly your name and passport number (Pleaseforwardphotostate copy of old passport if current passport number differs from EPF recoros) Sila bekalkan alamat ahli di luai negara Please give your overseas correspondence address

52

60

DOKUMENTAMBAHAN ADDITIONAL DOCUMENT 61 SIJII Perkahwinan (Sekiranya nama di dalam pasport berlainan dengan rekod KWSP) Marriage Certificate (If name in the passport aiffers from EPF records)

Tandatangan Ahli Veinbf" > Signature Tandatangan Penenma Rf teiver s Signature

Tankh Date Tankh Date

KUMPULAN WANG SIMPANAN PEKERJA 1 O&OS 2001

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991 PEMBERITAHUAN PENGELUARAN MENINGGALKAN NEGARA

KWSP 96 (AHL) PERCUMA

PERHATIAN MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATAU TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEM6ERIKAN APA-APA IOKUMEN PALSU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MELAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BOLEH DIDENOA ATAU DIPENJARA ATAU DUA-DUANYA
ATTENTION ANY PERSON WHO MAKES ANY UNTRUE OR FALSE STATEMEN1S OR PRODUCES ANY FALSE DOCUMENTS REGARDING ANY MATERIAL PARTICUtARS IS COMMITTING AN OFFENCE ANO IF FOimO GUL TY SHALL BF LIABLE TO 'MPRISONMENT OR FINE OR BOTH

KEGUNAAN KWSP SAHAJA

FOR EPF USE ONLY

BUTIRANAHLI
PARTICUIARS OF MEMBER

nxo
MOD PEMBAYARAN
MODE OF PAYMEN1

KP DC

1 NOMBORAHU
MtMBERS NUMBER

2 NOMBOR KAD PENGENALAN 12 DIGIT

<1 DIGIT IDENTITY CARD NUMBER

J
3. NOMBOR KAD PENGENALAN 7 DIGIT
7 DIGI1 IDENTITY CARD NUMBER

OUT
4 NOMBOR POLIS/TENTERA/PASPORT/DSB

nxxxixx

POLICEMUTARY/PASSPORTNUMBER/ETC

WARAN
WARRANT

5 NAMA MENGIKUT KAD PENGENALAN/PASPORT

Nl^MF AS PER THE APPLICANTS IDENTITY CARD/PASSPORT

6 KETURUNAN

ORAFBANKAS'NG
FORE'GN BANK DRAFT

n
9 SEKTOR PEKERJAAN
EMPLOYMENT SECTOR

RACE

APAHAN BAYARAN ] tW'KWlFSS

P K R F D I T K E AKAUN BANK
DIRECCREDITING

ARIKHL/HIR

I J\N1INA
GENDER

DATEOF8IR~H

H
j c M b AKAUN
YPE OF ACCOUN1

H
D

B
M

8
M

T V

LELAKI
MALE

BCKERJASENDIRi i f ( . f EMPLOYED KERAJAAN

GOVERNMENT

SWASTA
PRIVATE

PEREMPUAN
FEMALE

TIDAK BEKERJA
UNEMPLOYED

KONVtNSIONA
I CONVENTIONAL

[ ALWADIAH L ALWADIAH 10 ALAMATArlU

MEMBER S ADDRESS

POSKOD
POSTCODE

BANDAR

CITY

DISEMAK OLEH PEGAWAI PENYEMAK

CHECKED BY OFFICER IN CHARGE

NEGERI

nzninzinin "i_ nzn :n _ m

11 NOMBOR TEL EF ON PEJABAT

STATE

rrxx
'ESIDlNCEJTLEPHONEI

OFHCt IELEPHO'IE NUMBER vVARAN WARRANT

12 JENIS PEMBAYARAN DPC OF PAYMENT ARAHAN BAYARAN

WARRANTLESS

DRAFBANKASINC NOMBOR IFLEFON RUMAH

UMBER/HANWHONE FOREIGN BANK DRAF i

KREDIT KE AKAUN BANK

DIRECT CREDITING

J LJ
BUTIRAN AKAUN BANK
PAPTICULARS OFBANKACK-OUNI

IAWKH
OATt

13 KODBANK
BANK CODE

14 NOMBOR AKAUN BANK

BANKAt^OLNlNbMbER

xixixxLxn

15 JENbAKALN
TYPE OF ACCOUM

KONVENSIONAL CONVENTIONAL AL WADIAH AL WADIAH

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991.
/ HEREBY APPLY TO WITHDRAW VY EPF CREDIT IN ACCORDANCE WITH THE EPF ACT 13S1

16.
JENIS PENGELUARAN TYPE OF WITHDRAWAL NOMBORAHLI
MEMBER'S NUMBER

HH H

jgjjj

NOMBOR K/P IDENTITY CARD

NUMBER

PEMBERITAHUAN : OISAHKAN OLEH: PEGAWAI PENGESAH

NOTIFICATION VERIFIED BY OFFICER IN-CHARGE

CAP IBU JARI KIR! DAN KANAN AHLI (MESTI DITURUNKAN DENGAN TERANG DAN PENUH MENGGUNAKAN PAD CAP IBU JARI BERWARNA HITAM1
LEFT AND RIGHT THUMB IMPRESSION OF THE MEMBER (MUST BE CLEARLY AND FULL Y AFFIXED USING BLACK INK THUMBPRINT PAD)

Klfil
LEEI

mm
BlSiU

NO K/TGN
STAFF REF NO

TARIKH
DATE

TARIKH
DATE

17. AKUAN SAKSI

WITNESS DECIMATION "SAYA DENGAN INI MENGAKU DAN MENGESAHKAN BAHAWA BUTIR-BUTIR PEMOHON TERCATAT Dl ATAS ADALAH MENGIKUT KAD PENGENALAN MALAYSIA / SINGAPURA / POLIS / TENTERA / PASPORT YANG SAVA TELAH PERIKSA SENDIRI DAN PEMOHON TELAH MENURUNKAN CAP IBU JARI KIRI DAN KANANNYA Dl HADAPAN SAYA" DILULUSKAN OLEH : PEGAWAI PELULUS 1
APPROVED By APPROVAL OFFICER 1 POLICE I MILITARY IDENTITY CARD I PASSPORT THAT I HAVE PERSONALLY EXAMINED AND THAT HE I SHE HAS DULY AFFIXED HIS I HER LEFT AND RIGHT THUMB IMPRESSION BEFORE ME '

NAMA PENUH SAKSI

FULL NAME OP WITNESS

NO KAD PENGENALAN SAKSI

IDENTITY CARD NO OF WITNESS

ALAMAT SAKSI

NO K/TGN STAFF REF NO

ADDRESS OF WITNESS

TANDATANGAN SAKSI
SIGNATURE Of WITNESS

TARIKH
DATE

JAWATAN DAN COP RASMI

DESIGNATION AND OFFICIAL STAMP

TARIKH
DATE

NOTA ;

ttSSE BERIKUT ADALAH SENARAI ORANG YANG BOLEH MENJADI SAKSI

THE FOLLOWING PERSONS MAY ACT AS A WITNESS

PEGAWAI KWSP YANG TERDIRI DARIPADA

EPF OFFICER

MAJIKAN PEMOHON APPLICANTS EMPLOYER PEGAWAI KEDUTAAN MALAYSIA

MALAYSIAN EMBASSY OFFICER

PEGAWAI PELULUS 2
APPROVAL OFFICER 1

PEGAWAI KWSP GRED 18 KE ATAS

EPF OFFICER GRADE (8 AND ABOVE

PEGAWAI KAUNTER KWSP

EPF COUNTER OFFICER

NOTARIAWAM
PUBLIC NOTARY

NO K/TGN
STAFF REF NO

TARIKH
DATS

PANDUAN UNTUK MENGISI BORANG KWSP 9B (AHL) PEMBERITAHUAN PENGELUARAN MENINGGALKAN NEGARA GUIDELINES TO COMPLETE FORM KWSP 9B(AHL) LEAVING COUNTRY WITHDRAWAL
SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAH DIPENUHI DENGAN HURUF BESAR.
PLEASE READ THESE GUIDELINES CAREFULLY BEFORE COMPLETING THE FORM. THE FORM MUST BE COMPLETED IN BLOCK LETTERS. 1 Nombor Ahli Member Number

Isikan satu digit di setiap ruang dengan di dahului oleh digit '0' jika perlu, seperti contoh di bawah Fill in the space with one number, starting with '0' as shown below Contoh . 1234567 Example 1234567 1. NOMBOR AHLI
MEMBER'S NUMBER

0 Nombo

K dPenaenalan 12 Diqit a

12-Diait Identitv Card Number

Isikan nombor Kad Pengenaian 12 digit tuan/puan Jika tuan/puan belum memiliki Kad Pengenalan 12 digit, kosongkan ruangan mi Fill in your 12-digit Identity Card number Leave this space blank if you do not have any Contoh 610701-02-6157 Example 610701-02-6157 2. NOMBOR KAD PENGENALAN 12 DIGIT
12 DIGIT IDENTITY CARD NUMBER

Nombor Kad Pengenalan 7 Digit / Polis/ Tentera/ Pasport / Dsb 7-Digit Identity Card / Police/ Military/ Passport Number/ Etc Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah Fill m /our 7-digit Identity Card number,mcluding the initial as shown below 3. NOMBOR KAD ^ENGENALAN 7 DIGIT 7 DIGIT IDENTITY CARD NUMBER a) 1234567

h)

A1234567

c)

K1234567

d)
4.

H1234567

Nombor Polis/Tentera/Pasport/Dsb Police/Military/Passport Number/Etc Isikan Nombor Polis/Tentera/Pasport/Etc termasuk huruf awalan, seperti contoh di bawah Fill in your police/military'/passport number/etc, including the mtial as shown below 4. NOMBOR POLISH TNTERA/PASPORT/DSB POLICE/MILITARY/PASSPORT NUMBER/ETC a) I 1234567

b)

T 1234567

Nama Mengikut Kad

Name As Registered In Identity Card I Passport Tuliskan nama tuan/puan sebagaiinana yang tercatat dalam kad pengenalan tuan/puan Jika nama mengikut kad penqenalan lalah Norman bin Abdullah sha tuliskan nama seperti di bawah Write your name as registered in your identity card If your name as per your identity card is Norman bin Abdullah, please complete your name as follows

NAMA MENGIKUT KAD PENGENALAN / PASPORT NAME AS PER IDENTITY CARD / PASSPORT

r !

Keturunan

Isikan ruang dengan mengikut kod keturunan di bawah mi Jika tuan/puan berketurunan Melayu, isikan seperti di bawah Please complete this portion with rpference to the following For instance ifyou are a Malay 6. KETURUNAN RACE

Melayu Malay Cina Chinese India Indian Lam-lam Others

Bidayuh Bidayuh

Kadazan Kadazan Iban Iban

Tarikh Lahir Date of Birth Isikan tankh lahir tuan/puan mengikut susunan han, bulan dan tahun Jika tankh lahir tuan/puan pada 1 Julai 1961, isikan seperti di bawah Fill in your date of birth accordingtothe date, month and year If your date of birth is 1 July 1361, please fill in as follows

7 TARIKH LAHIR DATE OF BIRTH

H H D D 0 1
Jantina gender

B B T T M M Y Y 0 7 6 1

Tandakan jantina tuan/puan dengan [/) dalam ruang yang disediakan

Jika lelaki, tandakan {/) di ruang yang berkenaan

seperti di bawah Please tick{S) whichever is applicable Ifyou are a male, please fill in as follows 8. JANTINA GENDER LELAKI MALE PEREMUAN FEMALE

9.

Sektor Pekerjaan Ahli Employment Sector Tandakan {/) dalam ruang yang disediakan JiKa tuan/puan bekerja dalam seklor swasta, tanda (V) dalam ruang yang berkenaan seperti di bawah Please tick {/) whichever is applicable If you are working in the pnvate sector, please fill in as follows

9. SEKTOR PEKERJAAN EMPLOYMENT SECTOR

BEKERJA SENDIRI SELF EMPLOYED KERAJAAN GOVERNMENT SWASTA PRIVATE TIDAK BEKERJA UNEMPLOYED

10.

AlamatAhli
Member's Address

Tuliskan aiamat surat menyyat tuan/puan dengan lengkap Jika alamat surat menyurat tuan/puan adalah Lot 10, Kg Pant Kadir rmiur, Bukit Pasir, 84300 Muar, Johor Darul Takzim, sila penuhi seperti Derikut Please complete yow full address If your address is Lot 10, Kg Pant Kadir Timur, Bukit Pasir, 84300 Muar, Johor Darul Takzim please fill in as follows 10. ALAMAT AHLI
MEMBER'S ADDRESS

PA

II
POSKOD

M|U
I I

[R I

iS I U
I I L I

K
I

I [ M
I I

[ P IA | S 1
I i i __i

L _J

BANDAR
CITY

POSTCODE

i
Z I M

NEGERI
STATE

[7
11.

O I R

Nombor Telefon Ahli

Member's Telephone Number Isikan nombor telefon di ruangan yang disediakan di bawah Contoh Nombor Telefon Pejabat 07 9859450 dan Nombor Telefon Rumah/Bimbit 016-2070158 Please complete your telephone number (if any) as follows For example Office Telephone Number 07 9859450 and Residence Telephone Number I Handphone 016 - 2070158

11. NOMBOR TELEFON PEJABAT

OFFICE TELEPHONE NUMBER

NO TELEFON RUMAH/BIMBIT
RESIDENCE TELEPHONE NUMBER /HANDPHONE

12.

Jenis Pembayaran Type Of Payment Jika tuan/puan memilih kaedah pembayaran kredit ke akaun bank, tanda ( / ) di ruang yang berkenaan seperti di bawah : If you choose direct crediting, pleas$ tick ( ) as below: 12. JENIS PEMBAYARAN TYPE OF PAYMENT WARAN ARAHAN BAYARAN WARRANT WARRANTLESS DRAFBANKASING KREDIT KE AKAUN FOREIGN BANK BANK DRAFT DIRECT CREDITING

13.

KalBank
Bqnl{ Code Isikan nombor kod bank di ruangan yang disediakan seperti di bawah : Please fill in the bank code number in the space below: 13. KOD BANK BANK CODE

2
Kod Code 01 02 03 04 05 06 07 08 Nama Bank Name of Bank Arab Malaysian Bank Alliance Bank Southern Bank Utama Bank Bank Muamalat Arab Malaysian Finance Bank Islam

Nama Bank Name of Bank RHB Bank Maybank Bumiputra Commerce Public Bank Hong Leong Bank Hong Leong Finance Affin Bank EON Bank

Kod
Code

09 10 11 12 13 14 15

14.

Nombor Akaun Bank Bank Account's Number Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah: If your bank account's number is 1-23456-789012-3, please fill in as below:

15.

Jenis Akaun Type of Account Jika akaun tuan/puan adalah jenis konvensional, tanda ( V ) di ruang yang berkenaan seperti di bawah: Please tick (</) as below, if your type of account is conventional: KONVENSIONAL CONVENTIONAL

AL-WADIAH
AL-WADIAH

16.

Jenis Pengeluaran, Nombor Ahli, Nombor Kad Pengenalan dan Cap Ibu Jari Type of Withdrawal. Membership Number. Identity Card Number and Thumb Impression Isikan jenis pengeluaran, nombor ahli dan nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam. Kindly fill in type of withdrawal, membership number, identity card number and left and right thumb impression. The impression must be clear and fully affixed using black ink thumbprint pad.

17.

Afcuan Sakal Witness Declaration Senarai orang yang boleh menjadi saksi adalah seperti berikut: The following persons may act as a Witness: 1. PegawaiKWSPterdiridaripada: EPF Officer 2. Pegawai KWSP Gred 18 Ke atas EPF Officer Grade 18 and above Pegawai Kaunter KWSP EPF Counter Officer 4. Notari Awam Public Notary 3. Pegawai Kedutaan Malaysia Malaysian Embassy Officer

Majikan Pemohon Applicant's Employer