ITU/F003/01

KOLEJ POLY-TECH MARA ALOR SETAR

TINGKAT 1, BANGUNAN MARA MERGONG
SEBERANG PUTRA, 05150 ALOR SETAR, KEDAH
Tel: 04-7309255/7309257 Fax: 04-7341244

REPORT OF DUTY NOTIFICATION

STUDENT

Name :___________________________________________
I.D. No :___________________________________________
Organization Name :___________________________________________
Organization Address :___________________________________________
____________________________________________

INDUSTRIAL SUPERVISOR

Name :___________________________________________
Designation :___________________________________________
Contact No. :___________________________________________
Email :___________________________________________
Signature :___________________________________________
Organisation Official Stamp

The completed form must be submitted or faxed/email to:

Khaironnisa binti Razak
Industrial Training Unit
Kolej Poly-Tech MARA Alor Setar
Tel : 04-7309255/7309257
Fax: 04-7341244

e-mail: khaironnisa@gapps.kptm.edu.my

If this form is not returned within the stipulated date, it will be assumed that the student is not registered
and does not report for duty. Hence, no evaluation will be made on the student.