Kompetensi Dasar (KD):

3.1. Membedakan fungsi sosial, struktur teks, dan unsur kebahasaan beberapa
teks khusus dalam bentuk formulir isian yang digunakan di
perusahaan/bank/instansi lain, dengan memberi dan meminta informasi
terkait jati diri dan informasi yang relevan, sesuai dengan konteks
penggunaannya
4.1 Menangkap makna secara kontekstual terkait fungsi sosial, struktur teks,
dan unsur kebahasaan teks khusus dalam bentuk formulir isian yang
digunakan di perusahaan/bank/instansi lain, terkait jati diri dan informasi
yang relevan

A. THE DEFINITION

A form is a document (printed or electronic) with spaces in which we can write or enter
data.
Forms have existed for a significant amount of time, with historians of law having discovered
preprinted legal forms from the early 19th century that greatly simplified the task of drafting
complaints and various other legal pleadings. It is believed that the form was conceived by
mathematician and inventor Charles Babbage.

B. THE SOCIAL FUNCTION OF FORM

The purpose of form is to convey data or short detailed information for a certain purpose.
C. KINDS OF FORMS
There are many kinds of forms serving different functions such as;
• Purchase form
It is used to make legally binding purchase agreements between the sellers and the
buyers. They contain essential information such as the cost of the purchase, the terms of
payment and warranties.
• Order form
It is used by bussiness or companies as a convenient way of taking order from customers.
They contain information about exactly how much a particular order will cost.
• Reservation form
 It is important type of documents which are used when a person wants to reserve his
place or position at a place or an event. For example a reservation for a plane seat, hotels
rooms, a table in a restaurant, etc.
• Medical form
It is used to keep medical information about a patient that is under the care of a hospital
or a doctor. They also contain a documentation of a patient’s medical history and care.

D. THE LANGUAGE FEATURES OF FORM

In a form, you will find some common phares that are used to help you in filling the
form. Of course, the phrases used are different one to another based on the purpose of the form
itself. Following are common phrases used in a form;
 First name ....
 Last name/family name ...
 Date of birth ...
 Address ...
 Material status ...
 Nationallity...
 ID card no (KTP/SIM/Passport/other) …
 Any phone number (for emergency call) ...
Example:
E. GLOSARIUM

WORD MEANING
Form a paper or set of papers printed with spaces
in which answers to questions can be written
or information can be recorded in an
organized way.
Convey to express thought, feeling, or idea so that it
is understood by other people
Purchase form acquire something by paying for it
Order form the arrangement or disposition of people or
things in relation to each other according to a
particular sequence, pattern or method
Withdraw slip remove or take away (money) from a
particular place or position
Deposit slip a sum of money paid into a bank or building
society account
Reservation form the action of reserving something e.q
ordering something

Medical form Relating to the science or practice of

medicine

F. EXERCISES

Task 1. Observe the following forms. Pay attention to the function and the language used in the
forms. Then write any words or terms that you want to know from the forms.
FORM 1
Metro Saving Bank WITHDRAWAL
Date : No. B 2071349
Account number:

Name of Account Holder :

Account type :
Savings Loan
Checking Accounts Others

Amount :
In words :

Teller’s signature Depositor’s Signature

________________ __________________
FORM 2

FORM 3
FORM 4

FORM 5
Task 2: In pairs, answer the following questions!

1. How many forms that you have learned in Task 1?

2. Explain the differences between Form 1 and 2, 3 and 4, 5?
3. Pay attention to the function, the structure, and the language used in the texts.
Find and present the discussion result to the class.

Task 3. Match the following forms with the phrases in the box.

Direction: Read the following forms and match the forms with the phrase from the box.
1. Deposit Slip
2. Cash Withdrawal Slip
3. Check
4. Account Opening Form

1.

Metro Saving Bank WITHDRAWAL

Date : ___/___/_____
(dd/mm/yyyy) No. B 2071349
Account number :

Name of Account Holder : ____________________________________________

Account type :
Savings Loan
Checking Accounts Others
Amount :
________________________________________________________
In words :
________________________________________________________
2.

3.

4.
Task 4.Fill in the following form based on the information provided.

On September 4th, 2014, you want to withdraw Rp.555,000 from your savings account.
Your Account number is 220-31081972.
Metro Saving Bank WITHDRAWAL
Date : ___/___/_____
(dd/mm/yyyy) No. B 2071349
Account number :

Name of Account Holder : ____________________________________________

Account type :
Savings Loan
Checking Accounts Others
Amount :
________________________________________________________
In words :
________________________________________________________

Task 5. Complete the following forms with your own identity

1.

2.
3.
Metro Saving Bank WITHDRAWAL
Date : ___/___/_____
(dd/mm/yyyy) No. B 2071349
Account number :

Name of Account Holder : ____________________________________________

Account type :
Savings Loan
Checking Accounts Others
Amount :
________________________________________________________
In words :
________________________________________________________
Directions: Choose the correct answer of the following questions!
1. Document used by bussiness or companies as a convenient way of taking order from
customers is called ______.
a. Purchase forms d. Medical forms
b. Order forms e. Reservation forms
c. Feedback forms
2. Forms are used to keep medical information about a patient that is under the care of a
hospital or a doctor.
a. Purchase forms d. Medical forms
b. Order forms e. Reservation forms
c. Feedback forms
3. Feedback forms are documents used to maximize response in an unobtrusive and intuitive
way from clients or ______. The forms are used to provide feedbacks on performance,
quality and general opinions about an organization.
a. Organization d. quality
b. Customer e. opinion
c. performance

Read the following form to answer questions 4 to 7.

SPECIAL SUBCRIPTION OFFER FORM

4.
Subscribe to “WOMAN’S LIBERTY” magazine that recently received the TOP Brand Award from
5. of Fashion Designers.
Society
YES! Send me “WOMAN’S LIBERTY” magazine for 1 year (12 issues) at just Rp288,000, a
saving of 20% of the full cover price of Rp30,000.
Payment enclosed
Bill me

Name : Intan Permata

Title : Batik Designer
Company : Kencana Sari Batik Boutique
Address
4. Why: Bancar Asricomplete
did Intan Street II/16 Semarang
this form?
a. To enroll in a design course d. to win an Award
b. To apply for a designer e. To send magazine
Please allow four weeks for first issue.
c. To receive magazine
5. How much is the full cover price for each issue?
a. Rp24,000 d. Rp300,000
b. Rp30,000 e. Rp500,000
 c. Rp288,000
6. How long will it take for the first issue to be received?
a. One week d. One Month
b. Two weeks e. One year
c. Three weeks
7. The magazine comes ______.
a. daily d. every three months
b. weekly e. every six months
c. monthly

Fill the following form based on own information!

Metro Savings Bank WITHDRAWAL

Date: ………………………………….. 8) No. B 2071349
Account Numbers: 9)
Name of account holder : ……………………………………………………………………………………………………….10)
Account type : 11) savings loans
checking accounts others

Amount : …………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………… 12)
In words : …………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………… 13)

Signature 14)

_________________ __________________ 15)

Teller’s signature Depositor’s signature