BORANG E

BORANG PERMOHONAN PENDAFTARAN PENUBUHAN PPIM

DI SEKOLAH-SEKOLAH MENENGAH / RENDAH
NEGERI

:: PERAK
_______________________________________________

NAMA SEKOLAH

:: SEKOLAH
KEBANGSAAN BAGAN SERAI
_______________________________________________

ALAMAT SEKOLAH

:: LORONG
SEKOLAH 34300 BAGAN SERAI,PERAK
_______________________________________________

TARIKH PENUBUHAN :: 1990

_______________________________________________
NO.TELEFON

:: 05-7210423
_______________________________________________

BILANGAN AHLI

:: 41
ORANG
_______________________________________________

NAMA GURU PEMIMPIN

1 _____________________________________
PN.MARIAM BT MOHAMAD ISA
2 _____________________________________
PN.HJH.NORAZMAH BT.MANLANA
3 _____________________________________
PN.NOOR ZALINA BT ZAKARIA
4 _____________________________________
PN.NOOR SALMI BT.MOHD.NOOR
5 _____________________________________
PN.SURIYANA BT. SAPUAN
6 _____________________________________
PN.NORADILAH BT.MOHD.JEFRI
7 _____________________________________
CIK HAMIDAH BT IBRAHIM

TARIKH MEMOHON

: 22.02.2006
_____________________________________

_____________________
TANDATANGAN GURU
PEMIMPIN 1

_____________________
TANDATANGAN GURU
PEMIMPIN 1

_____________________
TANDATANGAN
GURU BESAR / PENGETUA
DAN COP

BORANG

BORANG YURAN TAHUNAN PPIM

SEKOLAH-SEKOLAH MENENGAH / RENDAH
NEGERI

PERAK
:: ____________________________________________________

NAMA SEKOLAH

SK WAWASAN PEKAN BARU

:: ____________________________________________________

ALAMAT SEKOLAH

PARIT BUNTAR,PERAK.
::34200
____________________________________________________

TARIKH PENUBUHAN :: ____________________________________________________

2004
NO.TELEFON

05-7177922
:: ____________________________________________________

BILANGAN AHLI

38 ORANG
:: ____________________________________________________

NAMA GURU PEMIMPIN

TARIKH

1 PN.
RAHAYU BINTI YATIM
____________________________________________
2 PN.FAUZIAH
BT YUSOFF
____________________________________________
3 PN.CHE
MAHANI BT OTHMAN
____________________________________________
4 PN.ZARIDAH
BT MAT ZIN
____________________________________________
5 CIK
HASLINDA BT SAMSUDIN
____________________________________________
6 PN.
NAJIHA BT HAJI BAKAR
____________________________________________
7 PN.
ANISAH BT MOHD YUSOF
____________________________________________

8 PN.
MARIAM BT MOHAMAD ISA
____________________________________________
:: 3.3.2011
____________________________________________________

_____________________
TANDATANGAN GURU
PEMIMPIN 1
_____________________
TANDATANGAN GURU
PEMIMPIN 11

___________________________
TANDATANGAN
GURU BESAR / PENGETUA
DAN COP

BORANG G

PERGERAKAN PUTERI ISLAM MALAYSIA

BORANG UNTUK MENJADI AHLI
(GURU / PENSYARAH / PEMIMPIN DAN AHLI DI LUAR SEKOLAH)
Bil. Pendaftaran
: ____________________________________________________________________________________
(Kod Perhubungan Negeri Dan Bil)
Nama Penuh

:: _____________________________________________________________________________________

Alamat

SEK. KEB.
:: ___________________________________

Perhubungan Negeri

PERAK
Daerah
: ___________________________________

Tarikh

: ____________________________________________________________________

No. Tel

_____________________________________
: ____________________________________
KERIAN

Yuran 20:
No. Resit

:: _________________________________________________________________________________________

Disahkan oleh
: ___________________________________________________________________________________
(Jawatankuasa Negeri Dan Daerah)
Tarikh

: ___________________________________________________________________________________
BORANG G

PERMOHONAN MENJADI AHLI

( Salinan)
Untuk Simpanan Ibu Pejabat PPIM
Kod No.

:: _____________________________________________________________________________________________

Nama Penuh Pemohon

Alamat

BINTI YATIM
:RAHAYU
____________________________________________________________________________________

SEK.KEB.
WAWASAN, PEKAN BARU, 34200 PARIT BUNTAR
____________________________________________________________________________________________

Yuran 20:
No. Resit

2010
: ___________________________________

No. Tel

017 9294001
_______________________________________

Tanda tangan

.
( RAHAYU BT YATIM)
BORANG

PERMOHONAN MENJADI AHLI

( Salinan)
Untuk Simpanan Ibu Pejabat PPIM
Kod No.

:: _____________________________________________________________________________________________

Nama Penuh Pemohon

T SAMSUDIN
:HASLINDA
____________________________________________________________________________________

Alamat

SEK.
KEB. WAWASAN, PEKAN BARU, 34200 PARIT BUNTAR
____________________________________________________________________________________________

Yuran 20:

: 2010

No. Resit

RM5.00
___________________________________

No. Tel

012
5808536
_______________________________________

Tanda tangan

.
( HASLINDA BT SAMSUDIN )

BORANG G

PERMOHONAN MENJADI AHLI

( Salinan)
Untuk Simpanan Ibu Pejabat PPIM
Kod No.

:: _____________________________________________________________________________________________

Nama Penuh Pemohon

MAHANI BT OTHMAN
:CHE
____________________________________________________________________________________

Alamat

SEK.KEB.
WAWASAN, PEKAN BARU, 3400 PARIT BUNTAR
____________________________________________________________________________________________

Yuran 20:

: 2010

No. Resit

RM5.00
___________________________________

No. Tel

05
7171229
_______________________________________

Tanda tangan

.
( CHE MAHANI BT OTHMAN )
BORANG

PERMOHONAN MENJADI AHLI

( Salinan)
Untuk Simpanan Ibu Pejabat PPIM
Kod No.

:
: _____________________________________________________________________________________________

Nama Penuh Pemohon

FAUZIAH BT YUSOFF
: ____________________________________________________________________________________

Alamat

SEK.
KEB. WAWASAN, PEKAN BARU, 34200 PARIT BUNTAR
____________________________________________________________________________________________

Yuran 20:

: 2010

No. Resit

RM5.00
___________________________________

No. Tel

012
4135260
_______________________________________

Tanda tangan

.
(FAUZIAH BT YUSOFF)
BORANG G

PERMOHONAN MENJADI AHLI

( Salinan)
Untuk Simpanan Ibu Pejabat PPIM
Kod No.

:: _____________________________________________________________________________________________

Nama Penuh Pemohon

NORAIN BT RAMLI
:SITI
____________________________________________________________________________________

Alamat

SEK.
KEB. WAWASAN, PEKAN BARU, 34200 PARIT BUNTAR
____________________________________________________________________________________________

Yuran 20:

:2010

No. Resit

RM5.00
: ___________________________________

No. Tel

012
4647230
_______________________________________

Tanda tangan

.
( SITI NORAIN BT RAMLI )

BORANG G

PERMOHONAN MENJADI AHLI

( Salinan)
Untuk Simpanan Ibu Pejabat PPIM
Kod No.

:: _____________________________________________________________________________________________

Nama Penuh Pemohon

BT ABU BAKAR
:NAJIHA
____________________________________________________________________________________

Alamat

SEK.
KEB. WAWASAN, PEKAN BARU, 34200 PARIT BUNTAR
____________________________________________________________________________________________

Yuran 20:

:2010

No. Resit

RM5.00
: ___________________________________

No. Tel

019
4265838
_______________________________________

Tanda tangan

.
(NAJIHA BT ABU BAKAR)
BORANG G

PERMOHONAN MENJADI AHLI

( Salinan)
Untuk Simpanan Ibu Pejabat PPIM
Kod No.

:
: _____________________________________________________________________________________________

Nama Penuh Pemohon

BT MOHD YUSOF
:ANISAH
____________________________________________________________________________________

Alamat

SEK.
KEB. WAWASAN, PEKAN BARU, 34200 PARIT BUNTAR
____________________________________________________________________________________________

Yuran 20:

:2010

No. Resit

RM5.00
: ___________________________________

Tanda tangan

.
( ANISAH BT MOHD YUSOF )

No. Tel

017
4708066
_______________________________________

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