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28108144291a1b1c10923335 1. Bersama - sama ini disertakan :
00000
2f0156272d10a162434e125f1 A) RM 20.00 yuran masuk
1718191a262728292a353637 B) RM 500.00 untuk saham minimum
C) RM 500.00 untuk 1 lot saham tambahan (RM 500 x lot = RM.
38393a434445464748
.)
D) Sekeping gambar dan salinan kad pengenalan

2. Saya bersetuju, selama saya menjadi ahli akan patuh kepada Undang-undang Kecil Koperasi KKSSK Pulau
Pinang Berhad dan pindaan-pindaan atau tambahan sah yang dibuat kepada Undang-undang Kecil itu.
NO. STAF : NO. AHLI KKSSK :
NAMA PENUH :
(Cik/Puan/Encik/Dr./Profesor/Prof.Madya)
Mengikut Undang-undang Kecil Koperasi, 22 (1) Seseorang anggota boleh menarik diri daripada Koperasi ini
dengan memberi notis bertulis tiga bulan terlebih dahulu kepada Lembaga. Atas sebab yang munasabah,
Lembaga boleh membenarkan penarikan diri dalam tempoh yang singkat. Apabila saya berhenti menjadi ahli, sila
kembalikan harga penuh saham saya dan dividen kepada saya di alamat tetap. Jika saya tidak dapat dihubungi
oleh kerana beberapa sebab, saya bersetuju mendermakan harga penuh saham saya kepada Koperasi KKSSK

Pulau Pinang Berhad untuk kegunaan kebajikan.

Tarikh : Tandatangan Pemohon : ...
NO. KAD PENGENALAN BARU :
BANGSA : JANTINA : JAWATAN :
ALAMAT TETAP :
ALAMAT JABATAN :
TEL H/P : TEL. PEJ SAMBUNGAN :
NO. FAX : E-MAIL :

BAHAGIAN A (Diisi oleh Pemohon)

BAHAGIAN B (Untuk Kegunaan Pejabat)
Disahkan layak menjadi Ahli Koperasi KKSSK Pulau Pinang Berhad, pada
Mesyuarat Lembaga Ke - . Pada ..
Tandatangan : Setiausaha / Pengerusi :
Nombor Keanggotaan

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BAHAGIAN C (Borang Penama)

Tarikh : .
Nama (Huruf Besar) : .
Jab/ Pusat Pengajian : .
No. Staf : .
No. Ahli Koperasi : .
Setiausaha
Lembaga Pengarah
Koperasi KKSSK Pulau Pinang Berhad
Tertakluk kepada Undang - undang Kecil Perkara 18 (1) : Tiap - tiap anggota Muslim hendaklah
menamakan seorang wakil di sisi undang - undang untuk menerima setelah dia mati, wang yang
terhak baginya di dalam Koperasi ini bagi diagihkan kepada waris yang berhak mengikut hukum
Islam
Tertakluk kepada Undang - undang Kecil Perkara 18 (2) : Tiap - tiap anggota bukan Muslim
hendaklah menamakan seorang atau lebih daripada seorang sebagai penama.
Tertakluk kepada Undang - undang Kecil 11 : Seseorang penama boleh diterima menjadi anggota
dan penama yang demikian itu hendaklah dianggap telah menjadi anggota mulai tarikh anggota
yang digantikannya itu diterima sebagai anggota.
Nama Penama : .
No. Kad Pengenalan : .
No. Staf : .
Jab / Pusat Pengajian : .
Pertalian : .
Saya ..bersetuju menjadi penama / wasi
kepada .....sebagaimana yang dinyatakan di
bawah perkara 18(1), 18 (2) dan perkara 11 Undang - undang Kecil Koperasi KKSSK Pulau Pinang Berhad

Tarikh : . Tandatangan Pemohon: