SEKOLAH MENENGAH KEBANGSAAN KERAMAT WANGSA,

NO.3, JALAN 23/56, OFF JALAN TAMAN SETIAWANGSA, 54200 KUALA LUMPUR.

SIJIL BERHENTI SEKOLAH

( SCHOOL LEAVING CERTIFICATE )

Nama
(Name)
No.Pendaftaran Sekolah No.K.P.
(Admission Number) (I.C. No : )
Tarikh Lahir Tempat Lahir
(Date of birth) (Place of birth)
Nama Bapa / Penjaga
(Name of Father/Guardian)
Sekolah Dahulu
(Previous School)
Tarikh Masuk Tingkatan
(Date of Admission) (Form)
Tarikh Berhenti 2020: 31/12/2020 5
Tingkatan
(Date of Leaving) 2021: 9/02/2021 (Form)
Kedatangan Dalam Tahun Ini 2020: /211
(Attendance during the year) 2021: /13
Peperiksaan Lulus PENTAKSIRAN TINGKATAN TIGA (PT3)
(Examination Passed)
Sukan dan Permainan
(Games and Athletics)
Persatuan dan Kelab
(Societies and Clubs)
Persatuan Beruniform
(Uniformed Units)
Kelakuan
(Conduct)
Sebab Berhenti TAMAT TINGKATAN LIMA
(Reason of Leaving)
Catatan -
(Remarks)

TARIKH
(Date) ….……………………………… ………………………………………………

Pengetua (Principal)
 SEKOLAH MENENGAH KEBANGSAAN KERAMAT WANGSA,
NO.3, JALAN 23/56, OFF JALAN TAMAN SETIAWANGSA, 54200 KUALA LUMPUR.

SURAT AKUAN
(TESTIMONIAL)

A. MAKLUMAT AM (General Particular )

Nama
(Name)
No.K.P. Tarikh Lahir
(I.C. No : ) (Date of birth)
Tarikh Masuk Sekolah Ini No.Pendaftaran Sekolah
(Year Admitted to this School) (Admission Number)
Tingkatan Tertinggi Peperiksaan Tertinggi Diambil
(Highest Form Completed) (Highest Examination Taken)

B. SAHSIAH ( Personality )

Sikap Terhadap Pelajaran 5 Kepimpinan

(Attitude towards Studies) (Leadership)
2 Displin Dalam Tugas 6 Kesungguhan Dalam Tugas
(Discipline at Work) (Division to Duty)
3 Sikap Tanggungjawab 7 Daya Usaha
(Sense of Responsibility) (Initiative)
4 Pergaulan
(Sociability)

C. KEGIATAN KO-KURIKULUM ( Extra-Curricular Activities )

PERSATUAN/KELAB/UNIT TAHUN AHLI/JAWATAN DIPEGANG / PENILAIAN

BERUNIFORM/SUKAN/PERMAINAN (Year) PERINGKAT YANG DIWAKILI (Assessment)
(Societies/Clubs/Uniform-Units/Sport/Games) (Member/Position Held/Level)

D. KELAKUAN PANDUAN UNTUK PENILAIAN

(Conduct) (Key to Assessment Scale)
A-Terbaik (Excellent)
E. KEDATANGAN B- Baik (Good)
(Attendance) C-Sederhana (Fairly Good)
D-Lemah (Poor)
TARIKH
(Date) ….……………………………… ……..………………………………………

Pengetua (Principal )