BORANG PERMOHONAN PAS RAPID PENANG RAPID PENANG PASS APPLICATION FORM

Sila tanda X pada kotak yang berkenaan: Sila letakkan Please mark an X where appropriate: gambar disini
Rapid Rapid Youth Please attach Preferred

photo here

Rapid Concession OKU card

Rapid Emas

NAMA PEMOHON
NAME NO. KAD PENGENALAN NRIC NO.

: :

______________

SEKOLAH/KOLEJ/UNIVERSITI : SCHOOL/COLLEGE/UNIVERSITY TINGKATAN/TAHUN FORM/STANDARD ALAMAT SURAT MENYURAT

CORRESPONDENCE ADDRESS :

NO. TELEFON

: (R)(H)

(HP)

TELEPHONE NO.

JIKA BERLAKU KECEMASAN, SILA HUBUNGI:

IN CASE OF EMERGENCY, PLEASE CONTACT

Name

Nama:

Telephone

No. Tel:

Hubungan: TANDATANGAN:
SIGNATURE

Relationship

DATE

TARIKH

Sila lengkapkan senarai maklumat di bawah semasa membuat permohonan : Please ensure all forms are accompanied by the following documents:

1. 2. 3.

2 keping gambar berukuran pasport terbaru (tidak dipulangkan) 2 Passport sized photographs (Non-Returnable) 1 salinan kad pengenalan/surat beranak 1 Copy of IC or Birth Certificate 1 salinan kad pelajar dan surat pengesahan pelajar (bagi pelajar University/Kolej) 1 Copy of student card and verification letter (for college/university)

4.

1 salinan Pasport (bagi pekerja asing) 1 copy of Passport for foreigner workers.

RPG/F/CCD-Permohonan Pas/A/07-2011

3/4/2013 15:53 a3/p3

5.

Sekiranya kad Rapid Youth, Rapid Preferred atau Raipd Emas hilang atau rosak, denda sebanyak RM10.00 akan dikenakan. In the event of lost/spoilt Rapid Youth, Rapid Preferred or Rapid Emas, an RM10.00 penalty will be imposed.

RPG/F/CCD-Permohonan Pas/A/07-2011

3/4/2013 15:53 a3/p3