LAMPIRAN A

CABARAN MY INNOVATION
PENTADBIRAN KERAJAAN NEGERI SELANGOR
TAHUN 2014

Peringkat Penyertaan

Individu

Kumpulan Kecil

Jabatan / Agensi

Sekolah / IPT

MAKLUMAT PERIBADI / KUMPULAN / JABATAN

Nama Individu / Kumpulan / Jabatan / Sekolah / IPT
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MAKLUMAT KUMPULAN KECIL / JABATAN*

*Untuk penyertaan kumpulan Kecil / jabatan sahaja
Jumlah Ahli : .........................................................................................................
Nama Ahli

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Alamat Individu / Kumpulan / Jabatan / Sekolah / IPT

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LAMPIRAN A
No. Perhubungan
No. Tel ( R ) : .........................................................................................................
No. Tel ( P ) : ...........................................................................................................
No. Tel ( B ) : .........................................................................................................
No. Faks

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E-Mail

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RINGKASAN HASIL INOVASI*

*Sila gunakan lampiran jika ruangan tidak mencukupi

Penerangan Hasil Inovasi

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Kebaikan Hasil Inovasi

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