BORANG PA 1/13

FORM PA 1/13

JABATAN TENAGA KERJA SEMENANJUNG MALAYSIA

LAPORAN TENTANG PEKERJA ASING YANG DIGAJIKAN
(SEKSYEN 60K(1) AKTA KERJA 1955)
REPORT ON EMPLOYMENT OF FOREIGN EMPLOYEE
(SECTION 60K(1) EMPLOYMENT ACT 1955)

TANGGUNGJAWAB MAJIKAN UNTUK MELAPOR

DUTY OF EMPLOYER TO REPORT
Borang ini hendaklah dilengkapkan oleh majikan dan dikemukakan dalam dua (2) salinan setiap kali menggajikan pekerja
asing dan hendaklah dihantar serta diakui terima oleh Pejabat Tenaga Kerja terdekat dalam tempoh empat belas (14)
hari dari tarikh penggajian pekerja asing tersebut.
This form shall be completed by employers and be submitted in two (2) copies each time the employer employs foreign
employees and shall be submitted so as to be received by the nearest Labour Office within fourteen (14) days of the
employment of such foreign employees.

PERINGATAN
REMINDER
Kegagalan mematuhi seksyen 60K(1) Akta Kerja 1955 adalah satu kesalahan di bawah seksyen 60K(5) Akta dan jika
disabit kesalahan boleh didenda tidak melebihi RM 10,000.
Failure to comply with section 60K(1) of the Employment Act 1955 is an offence under section 60K(5) of the Act and if
convicted may be fined not more than RM 10,000.

BAHAGIAN I
PART I
1
MAKLUMAT MAJIKAN (SILA GUNAKAN HURUF BESAR)
PARTICULARS OF EMPLOYER (PLEASE USE CAPITAL LETTERS)

1 Nama majikan P R E C I S I O N S P R I N G S
Name of employer
( M ) S D N B H D

2 Alamat berdaftar 4 2 4 9 J A L A N S I R A M
Registered address

1 2 1 0 0 B U T T E R W O R T H
Poskod Daerah / Bandar
Postcode District/City

P U L A U P I N A N G
Negeri
State

3 Nombor pendaftaran syarikat/perniagaan (pemilik tunggal/perkongsian)

Company/business registration number (sole proprietor/partnership)
1 3 8 2 8 7 - K

4 No. telefon 0 4 3 1 4 8 2 8
Telephone no.

1
5 No. faks 0 4 3 1 4 8 2 2 9
Fax no.

6 Alamat emel H R O @ p s p r i n g s . c o m
Email address
7 Alamat tempat pekerjaan
(Sekiranya berbeza daripada di atas)
Place of employment
(If differ from above)

Poskod Daerah / Bandar

Postcode District/City

Negeri
State
8 Jenis Perniagaan PERKILANGAN
Type of business

9 No. telefon
Telephone no.
10 No. faks
Fax no.
11 Alamat emel
Email address

BAHAGIAN II
PART II
MAKLUMAT PEKERJA ASING
INFORMATION OF FOREIGN EMPLOYEE

12 Bilangan pekerja asing yang baru digajikan 0 8

Number of newly employed foreign employees

13 Bilangan pekerja asing yang sedang digajikan Bilangan Pekerja Asing

Jantina
(Tidak termasuk yang baru digajikan di perkara 11) Number of foreign
Gender
Number of foreign employees employed employees
(Not including newly employed in para 11)
Lelaki
Male 61
Wanita
Female 12

Jumlah
Total 73

14 Maklumat pekerja asing yang baru digajikan (Sila lengkapkan Lampiran A)

Particulars of newly employed foreign employees (Please complete Appendix A)

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 BAHAGIAN III
PART III
PENGAKUAN MAJIKAN
EMPLOYER'S DECLARATION

Dengan ini saya mengaku dan mengesahkan bahawa segala maklumat yang diberikan adalah benar dan betul.
I hereby declare and confirm that all the information provided herein is true and correct.

Tarikh : 14/05/2018 Tandatangan :

Date Signature

Nama : KHOR SENG HANG

Name

Jawatan : PENGARAH
Designation
Ketua Pegawai Eksekutif/Pengarah Urusan/Pengurus Besar
Cop syarikat : /Pemilik
Stamp of company Chief Executive Officer/Managing Director/General Manager
/Owner

AKUAN PENERIMAAN
ACKNOWLEDGEMENT

Tarikh & masa : Nama :

Date & time Name

Jawatan :
Designation

Cop rasmi jabatan :

Department's official stamp

Segala maklumat yang diberikan dalam borang ini adalah SULIT

All information provided in this form is CONFIDENTIAL

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 Lampiran A
Appendix A
MAKLUMAT PEKERJA ASING YANG BARU DIGAJIKAN
PARTICULARS OF NEWLY EMPLOYED FOREIGN EMPLOYEES
Gaji pokok
sebulan Tarikh
Basic digaji
Bil Nama No. pasport Warganegara Jantina Pekerjaan monthly Date of
No Name Passport no. Citizen Gender Occupation wages employment
1 JARKA MAGAR KHEM KUMARI 10727872 NEPAL FEMALE OPERATOR RM1000.00 30.04.2018
2 SYANGTAN SAMA MAYA 106520043 NEPAL FEMALE OPERATOR RM 1000.00 30.04.2018
3 TAMANG SITA MAYA 10813155 NEPAL FEMALE OPERATOR RM1000.00 30.04.2018
4 B.K SAMJHANA 10589889 NEPAL FEMALE OPERATOR RM1000.00 30.04.2018
5 TAMANG SUSHILA 10813147 NEPAL FEMALE OPERATOR RM1000.00 30.04.2018
6 TAMANG SITA 09292072 NEPAL FEMALE OPERATOR RM1000.00 30.04.2018
7 GHALAN PUJA 10553475 NEPAL FEMALE OPERATOR RM1000.00 30.04.2018
8 SUNAR KUMARI 09033427 NEPAL FEMALE OPERATOR RM1000.00 30.04.2018

(Sila gunakan lampiran sekiranya ruangan ini tidak mencukupi)

(Please use annexure if the column is insuffient)