--------------------------------------------------------------------------------------------------------------------------------------

BORANG KONVOKESYEN 2021

GAMBAR
PELAJAR

CAWANGAN KPTI
KPTI HQ
-------------------------------------------------------------------------------------------------------------------------

MAKLUMAT PELAJAR

1. NAMA MOHD HISHAM SURGI

:______________________________________________________________
741009-10-5713
2. NO K/P :______________________________________________________________

3. UMUR 47 TAHUN
: ______________________________________________________________

4. ALAMAT NO 2, TMN AIR MANIS 45200, SABAK BERNAM

:______________________________________________________________
SELANGOR
_______________________________________________________________

5. NO TEL 013-2633732
: ______________________________________________________________

6. EMEL : Mohdhishamsurgi74@gmail.com
:______________________________________________________________
GURU
7. PEKERJAAN : ______________________________________________________________
DIPLOMA PENGAJIAN ISLAM & BAHASA ARAB
8. NAMA KURSUS DIPLOMA/IJAZAH/MASTER : _____________________________________
1 SEPTEMBERI 2018
9. TARIKH AMBILAN : _______________________________________________________

10.TARIKH TAMAT 31 DISEMBER 2019

________________________________________________________
3 SEMESTER
11. TEMPOH SEMESTER : ______________________________________________________

Catatan penting: Saya bermula dengan sem 2, kemudian sem 3, diakhiri dengan sem 1. Dan saya ada
buat satu semester penangguhan iaitu 1 Mei 2019 – 31 Ogos 2019

1 September 2018 – 31 Disember 2018 (Join Sem 2)

1 Januari 2019 – 30 April 2019 (Join Sem 3)

1 September 2019 – 31 Disember 2019 (Join Sem 1)

** YURAN KONVO RM300 : TERMASUK SEWA JUBAH, SEWA DEWAN & PERALATAN , JAMUAN
MAKAN DAN LAIN-LAIN LAGI.
**SILA BUAT BAYARAN KE AKAUN KPTI : BIMB 12056010030760 MULAI 15 JANUARI 2021
DISAHKAN OLEH :

.................................................................................
( )
PENGURUS CAWANGAN :
--------------------------------------------------------------------------------------------------------------------------------------

BORANG KONVOKESYEN 2021

GAMBAR
PELAJAR
CAWANGAN KPTI

-------------------------------------------------------------------------------------------------------------------------

MAKLUMAT PELAJAR

1. NAMA :________________________________________________________________________

2. NO K/P :________________________________________________________________________

3. UMUR : _______________________________________________________________________

4. ALAMAT :_______________________________________________________________________

_________________________________________________________________________

5. NO TEL : _______________________________________________________________________

6. EMEL : ______________________________________________________________________________

7. PEKERJAAN : ______________________________________________________________________

8. NAMA KURSUS DIPLOMA/IJAZAH/MASTER : ________________________________________________

9. TARIKH AMBILAN : _______________________________________________________________

10.TARIKH TAMAT ________________________________________________________________

11. TEMPOH SEMESTER : __________________________________________________________________

Catatan penting : _________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

** YURAN KONVO RM300 UNTUK SEWA JUBAH, SEWA DEWAN & PERALATAN , JAMUAN MAKAN DAN LAIN-
LAIN LAGI.
**SILA BUAT BAYARAN KE AKAUN KPTI : BIMB 12056010030760 MULAI 15 JANUARI 2021

DISAHKAN OLEH :

.................................................................................
( )
PENGURUS CAWANGAN :