PNM.PK(O)PBN.

02(B1)
PUSAT KEBANGSAAN ISBN / ISSN
PERPUSTAKAAN NEGARA MALAYSIA
Aras 3, Anjung Bestari, 232, Jalan Tun Razak
50572 Kuala Lumpur
TEL: 03-26814329, 03-26871700 samb 4288
Email: isbn @pnm.gov.my

BORANG PENDAFTARAN PROGRAM ISBN /

ISBN PROGRAMME REGISTRATION FORM
LENGKAPKAN SEMUA BUTIRAN. PERMOHONAN TIDAK LENGKAP TIDAK AKAN DIPROSES

A. MAKLUMAT PENERBIT / PUBLISHER INFORMATION

Penerbit / Publisher : .........................................................Tarikh / Date: ..............................

Alamat/Address .........................................................
.........................................................
.........................................................
.........................................................
Telefon / Telephone: .........................................................Faks / Fax : ...............................
E-mail : .........................................................

B. SOAL SELIDIK PENERBITAN / QUESTIONNAIRE ON PUBLISHING

1. Sila nyatakan bilangan judul yang telah diterbitkan tanpa ISBN

Total of title have been published without ISBN:.....................................................................

2. Tarikh mula penerbitan

Publishing starting date :..............................................................................................................................

3. Bilangan judul yang dicadangkan diterbitkan dalam tempoh 10 tahun

10 years expectation number of titles will be published : ............................................................................

4. Bilangan judul dalam proses cetakan

Number of title in printing process : ...........................................................................................................

C. AKUAN / ACKNOWLEDGEMENT

Nama Pemohon / Applicant name:....................................................................................................................

Jawatan / Designation: ......................................................................................................................................

(Pengerusi/Pengurus/Setiausaha)

Tarikh Permohonan / Date Apply: ...................................................................................................................

..............................................................................
Tandatangan & Cop Rasmi Syarikat
Signature & Official Company Rubber Stamp

Nota / Note: Sila sertakan salinan Perakuan Pendaftaran syarikat (Borang D) atau salinan kad pengenalan bagi
penerbit individu / Please attach with the copy of ROC certificate or copy of identity card for individual publisher.

KEGAGALAN TUAN MENYEDIAKAN DOKUMEN YANG DIPERLUKAN AKAN MELEWATKAN

PERMOHONAN DI PROSES.