You are on page 1of 1

+ f+- Pg,, +-t 'tr tF + 6 (0077-os-JHR)

PERSATUAN PEI{GANIUT AGAMA BUDDHA


AMITABHA BATU PAHAT NEGERI JOHOR
24,25 & 26, Jalan Nlaju Barat, Taman Nlaju, 83000 Batu Pahat, Johor.
Tel : 07-432 8095 Fax : 07-.132 8095 Email : amtbbp201l@gmail.com

ftE|Fffi^ta#HrE #At{6
iia ( s ): n,lE
-tE trfd: trE (M) tra (F)

Name ( H ): Hb#ttGEll.C.No:
eHnHffEffi/Passport No. : HH:
HTEffi: ffi#
as=r
##8Hrff : EE,EH.

ES Email : flB:
fllIt/Address :

B.#.&,fr : tr A,B,C rufl+ft. DffiE,ffi DffiEi,fi D,L\mHE,ffi ntff trH{U ( ffiEfrEn )

E Hf E6'I*ETAH&.EEH *% z trft nE- r E=FaaEE )

*effif,6 fifr : ffiffi:


&rt : *Jffi:
fi*eL wa: atl=+
EBEH

tr1t[ : +ffi
TFEFfiEiE :

E. , ffift{ffi#Hfffi" ru€-F.,l , 6^e.*m-8rriE4,Er#H!fift.

+-#^tr€ fi*E^trA ffi€E


( ;rarnm t 9J#8. : ffiffH :

^*EE

t#H.fNMtr: EH:
,fffiil

HffiffiS+SiEH,KiF 86fr-WTHEh€ffi.Affr

You might also like