4/24/2018 Borang Permohonan Peperiksaan SHO\Sistem Permohonan Peperiksaan NIOSH

BORANG PERMOHONAN PEPERIKSAAN EXAMINATION APPLICATION FORM

PEGAWAI KESELAMATAN DAN KESIHATAN SAFETY AND HEALTH OFFICER
MAKLUMAT PEMOHON Applicant's Information
NO.RUJUKAN
Reference No. E006264SH
NAMA
Name
SIVARAAM A/ DANABALAN
MYKAD
Mykad 850830-07-5513
WARGANEGARA
Nationality
Malaysian
JANTINA
Gender Male
E-MEL
Email raamlogicsensor@gmail.com
NO. TELEFON
Telephone No.
PEJABAT/Office: - NO. TELEFON BIMBIT/Mobile No. : 0164488551
NO. FAKS
Fax No.
-
KELAYAKAN TERTINGGI
Highest Qualification SPM
NO. INDEKS
Indeks No. -
KAEDAH PEMBAYARAN
Payment Method
BAYARAN ONLINE / ONLINE PAYMENT
PILIHAN SURAT
MENYURAT Rumah / Home
Mailing Address?

NAMA SYARIKAT
Company Name KERJAYA PROSPEK (M) SDN.BHD
ALAMAT SYARIKAT NO 1, JALAN WANGSA PERMAI 3RD FLOOR BANGUNAN ONE WANGSA,
Company Address
TAMAN WANGSA PERMAI
52200 KUALA LUMPUR
W.P Kuala Lumpur
ALAMAT RUMAH NO 5, LORONG BUKIT MINYAK 17, TAMAN BUKIT MINYAK INDAH,
Home Address
14000 BUKIT MERTAJAM
Pulau Pinang
MAKLUMAT PEPERIKSAAN Examination Details
KERTAS
Paper Kertas 1 Kertas 2 Kertas 3
TARIKH
Date 25/06/2018 26/06/2018 26/06/2018
Lokasi
Location
Penang Penang Penang
Yuran (RM)
Fee
265 265 159
Jumlah Yuran (RM)
Total Fees
689

Saya mengaku segala kenyataan di atas adalah benar dan lengkap. I hereby declare that the
above information is true and correct.
Tarikh Permohonan Application Date : 24/04/2018

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