(PKNP .

26/PIN :1)

PERBADANAN KEMAJUAN NEGERI PAHANG

(Pahang State Development Corporation)
TINGKAT 16, KOMPLEKS TERUNTUM
JALAN MAHKOTA
25000 KUANTAN, PAHANG
TEL : 09-5135566
FAX: 09-5134530

APPLICATION FOR INDUSTRIAL LAND

(PERMOHONANAN TANAH KAWASAN PERINDUSTRIAN)

INDUSTRIAL SITE..............................................................................................................

KAWASAN PERINDUSTRIAN .........................................................................................

1. Name & address of applicant

(Nama dan alamat pemohon)
- here insert name of firm or company if land is to be held in the name of
firm/company
- (masukkan nama syarikat jika tanah yang dipohon hendak diletakkan di bawah
nama syarikat.)

2. Name & address of Directors/Partners/Proprietors.

(Nama dan alamat Pengarah-Pengarah/Perkongsian/Tuanpunya)

Name (Nama) Address (Alamat) Citizenship/I.C. No.

(Kewarganegaraan/No. K.P.)

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3. a. Approximate total area required ...................................................... ..acres/hectares
(Anggaran jumlah luas diperlukan)

b. Please furnish the proposed layout plan of the factory site

(Sila kemukakan pelan lakar ukuran tapak kilang/projek)

4. a. Intended use of the site

(Tujuan kegunaan tapak)

b. If factory, state the product (s) or nature of process

(Jika kilang, nyatakan keluarannya atau prosesnya)

5. Estimated Investment Cost

(Anggaran Modal Pelaburan)

a. - Land (Tanah) : RM
- Building (Bangunan) : RM
- Machinery (Jentera) : RM

Working capital : RM
(Modal Kerja)

Pre-operation Expenses : RM
(Perbelanjaan sebelum operasi)

b. Equity participation
(Penyertaan ekuiti)

% local (tempatan) :
% foreign (luarnegeri) :
% Bumiputera :

6. Estimated number of employees

(Jangkaan bilangan kakitangan/pekerja)

Male Female %
(Lelaki (Perempuan) Bumiputra
Managerial & Executive
(Pengurus & Eksekutif) ......................... ........................... ....................

Supervisory
(Penyelia) ......................... ........................... ....................

Technical & Sales

(Teknikal & Jualan) ......................... ........................... ....................

Skilled labour
(Pekerja mahir) ......................... ........................... ....................

Miscellaneous, e.g. clerk, typist

etc.
(lain-lain pekerja) ......................... ........................... ....................

7. Other information
 (Lain-lain keterangan)

Please submit (Sila kemukakan)

a. Project-brief or feasibility study
Project-brief atau kajian feasibiliti/kemungkinan projek

b. Business registration No. or No. of Certificate of Incorporation:

- please forward a photostat copy.
(No. Sijil Pendaftaran Perniagaan atau No. Sijil Perkongsian)
- sila sertakan salinan photostat.

8. I hereby declare that to the best of my knowledge and belief all the particulars
furnished above are true.

(Saya mengaku bahawa sepanjang pengetahuan saya, maklumat yang dinyatakan

diatas adalah benar).

Signature:
(Tandatangan)

Name (Nama) :

Designation :
(Jawatan)

Date :
(Tarikh)
 TO:

KETUA EKSEKUTIF
PERBADANAN KEMAJUAN NEGERI PAHANG
TINGKAT 16, KOMPLEKS TERUNTUM,
JALAN MAHKOTA,
25000 KUANTAN,
PAHANG, MALAYSIA.

For office use only

(Untuk kegunaan pejabat sahaja)

Form issued by :

Form received on :
by :

File reference :
Lot No. and size :
Misc :

Issued by :
Perbadanan Kemajuan Negeri Pahang
(Pahang State Development Corporation),
Tingkat 16, Kompleks Teruntum,
Jalan Mahkota, 25000 Kuantan, Pahang.
Tel : 09-5135566
Fax : 09-5134530