NO.

AKAUN CUKAI
TAKSIRAN : H
AKTA KERAJAAN TEMPATAN 1976 (LOCAL GOVERNMENT ACT 1976)
BORANG I (FORM I)
NOTIS JUALAN ATAU PINDAHMILIK (NOTICE OF SALE OR TRANSFER OF OWNERSHIP)
(Seksyen 160 / Section 160)

Datuk Bandar/ Mayor ,

Majlis Bandaraya Johor Bahru

Saya/Kami (I/We) _____________________________________________No. KP / No. Syarikat _______________

Dengan ini memberi notis sebagaimana dikehendaki di bawah Seksyen 160 (1) Akta Kerajaan Tempatan 1976
mengenai yang berikut :
(Hereby give notice as required under subsection 160 (1) of the local Government Act 1976 of the following : )

Perihal dan tempat letak Pegangan (Description and Situation) :

No. Lot (Lot No.) : _____________ No. Hakmilik (Title No.) : ______________ Mukim (Mukim) : _______________
Alamat Harta (Property Address ) : _________________________________________________________________

Nama Pemindahmilik/ Pemilik asal (Name of Transferor/ Previous Owner) :

______________________________________________________________________________________________
Nama Penerima Pindahmilik (Name of Transfree) :
1. _________________________________________________ No. K/P : ____________________________
2. _________________________________________________ No. K/P : ____________________________
3. _________________________________________________ No. K/P : ____________________________
4. _________________________________________________ No. K/P : ____________________________
Alamat surat-menyurat (Postal Address) : ___________________________________________________________

_____________________________________________________________________________________________
No. Telefon Pemilik (Owner Phone No.) : __________________________________________________________

Nombor atau Simbol Suratcara (Number or Symbol Instrument) :

Rujukan (Ref) : _____________________________ Jilid Pindahmilik (Transfer Vol.) : _______________________
Folio (Folio) : ______________________________
Tarikh Suratcara didaftarkan (Date of Registration of Instrument) : ______________________________________

Harga Beli (Purchase Price) : _________________ Tarikh Beli (Date of Purchase) : __________________________
Kenyataan (Statement) : _________________________________________________________________________
Bertarikh (Date) :_________________________ Tandatangan (Signature) : _______________________________

UNTUK KEGUNAAN MBJB (FOR MBJB USE ONLY)

Bayaran (Payment) : RM ____________________ No Resit (Receipt No.) : _____________________________

Tarikh (Date) : ___________________________
Disemak & Disahkan oleh (Verified By) :

_________________________
(Tandatangan / Signature)