PERBADANAN TAMAN NEGERI PERAK DARUL RIDZUAN

BORANG PERMOHONAN PERMIT

KEMASUKAN KE TAMAN NEGERI ROYAL
BELUM
ENTRY PERMIT APPLICATION FORM TO ROYAL BELUM STATE PARK

BUTIR-BUTIR DIRI PEMOHON / APPLICANT’S DETAIL

Nama Penguasaha
Pelancongan / Pemohon
:
Name of Tour Operator /
Applicant
No. Kad Pengenalan
:
Identification Card Number
Nombor Telefon
:
Telephone Number
Lokasi
:
Location
Tarikh Masuk & Keluar
:
Date of Entry & Departure
Jumlah Pelancong
:
Number of Tourist
Tujuan Lawatan
Purpose of the Visit

Lawatan Produk / Product Visit Memancing / Fishing

Penggambaran /
Penyelidikan / Research
Shooting
Tugas Rasmi / Official
Penyelenggaraan / Maintenance
Duty
Program (Kursus, Seminar, Bengkel,
Kem, Hari Keluarga) Lain-lain / Others :
Programme (Courses, Seminars, ........................................
Workshops, Camp, Family Day)

Penggunaan Kem Pelancongan (Sila nyatakan bilangan unit)

Tourist’s Camp (Please specify the number of units)

Kem Sungai Kem Sungai

Kem Sungai Tiang Kem Sungai Kejar
Papan Kenarong
Chalet Bilik Rumah Tamu Dormitory Keseluruhan Kem
Guest House Room Entire Camp

Tapak
Tapak Perkhemahan Tapak Perkhemahan
Perkhemahan
Campsite Campsite
Campsite

Dapur Dapur Dapur

Kitchen Kitchen Kitchen

Generator Keseluruhan Kem Keseluruhan Kem

Entire Camp Entire Camp

Keseluruhan Kem
Entire Camp

Nama Housebot / Bot, nyatakan nombor

pendaftaran
:
Name of houseboat/boat, please state the registration
number

Nama Penuh, Nombor Kad Pengenalan, Alamat dan Nombor

Senarai Peserta : Telefon / Salinan Passport
List of Participant Full Name, Identification Number, Address and Telephone Number / Copy of
Passport

Tandatangan Pemohon
Signature of Applicant
Nama / Name :
Tarikh / Date :

Ketua Kumpulan
:
Group Leader
No Telefon
:
Phone Number

No K/P / Passport No. Telefon /

No Nama / NameID Card / Passport Alamat / Address Tel. No
No.
1 MOHD KHAIROLAZUAN 801112-08-5871 104A, Jalan SM1A/4, 012-5742154
BIN ARIFFIN 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
2 NORULASFA NIZA BINTI 811208-08-6376 104A, Jalan SM1A/4, 012-5742154
ABDAL HAZIS 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
3 NUR ELLIESYA ALYAA 070222-08-0960 104A, Jalan SM1A/4, 012-5742154
BINTI MOHD 32040 SERI MANJUNG,
KHAIROLAZUAN PERAK DARUL
RIDZUAN.
4 MUHAMMAD IRFAN 110930-08-0471 104A, Jalan SM1A/4, 012-5742154
HAKIMI BIN MOHD 32040 SERI MANJUNG,
KHAIROLAZUAN PERAK DARUL
RIDZUAN.
5 MUHAMMAD IQHWAN 190628-08-1193 104A, Jalan SM1A/4, 012-5742154
HAKIMI BIN MOHD 32040 SERI MANJUNG,
KHAIROLAZUAN PERAK DARUL
RIDZUAN.
6 MOHAMAD AZHAR BIN 840322-11-5129 104A, Jalan SM1A/4, 012-5742154
MOHAMED 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
7 SAPINAH BINTI 840804-11-5236 104A, Jalan SM1A/4, 012-5742154
SHAMSUDDIN 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
8 JAMILAH BINTI 570530-11-5054 104A, Jalan SM1A/4, 012-5742154
ABDULLAH 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
9 AAQIF NAUFAL BIN 130410-08-0687 104A, Jalan SM1A/4, 012-5742154
MOHAMAD AZHAR 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
10 AILEEN MIQAYLA BINTI 220902-08-0578 104A, Jalan SM1A/4, 012-5742154
MOHAMAD AZHAR 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
11 MOHAMMED ZAIHEDDEN 770101-10-5567 104A, Jalan SM1A/4, 012-5742154
BIN IDRIS 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
12 HASNITA BINTI 790907-08-5460 104A, Jalan SM1A/4, 012-5742154
ABDULLAH 32040 SERI MANJUNG,
 PERAK DARUL
RIDZUAN.
13 MOHAMMED AIMAN 070521-08-0207 104A, Jalan SM1A/4, 012-5742154
FARISH BIN MOHAMMED 32040 SERI MANJUNG,
ZAIHEDDEN PERAK DARUL
RIDZUAN.
14 ARISSA ADRIANA BINTI 100705-08-0580 104A, Jalan SM1A/4, 012-5742154
MOHAMMED ZAIHEDDEN 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
15 MOHAMMED UMAR 150522-08-0989 104A, Jalan SM1A/4, 012-5742154
FAHIM BIN MOHAMMED 32040 SERI MANJUNG,
ZAIHEDDEN PERAK DARUL
RIDZUAN.
16 MOHD FADIL BIN HAD 820928-08-5157 104A, Jalan SM1A/4, 012-5742154
DAHARI 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
17 MOHD ZULKHAIRI BIN 861124-38-5905 104A, Jalan SM1A/4, 012-5742154
ANUAR 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
18 KHAIRUL HAIZAN BIN MD 900422-08-5301 104A, Jalan SM1A/4, 012-5742154
ISA 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
19 KAMARULZAMAN BIN 790209-03-5327 104A, Jalan SM1A/4, 012-5742154
SAIDI 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
20 SABRI BIN OTHMAN 780707-08-6793 104A, Jalan SM1A/4, 012-5742154
32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
21 RIZUAN BIN HAT 800121-08-6329 104A, Jalan SM1A/4, 012-5742154
32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
22 MOHAMMAD HAFIZ BIN 971004-08-5921 104A, Jalan SM1A/4, 012-5742154
JASMIN 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
23 MOHAMAD FUAD BIN 870619-06-5385 104A, Jalan SM1A/4, 012-5742154
JA’AFAR 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
24 MUHAMMAD TAQWIM 980425-14-5747 104A, Jalan SM1A/4, 012-5742154
BIN MOHD JASLAN 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
25 ANUAR BIN OMAR 671209-08-5875 104A, Jalan SM1A/4, 012-5742154
32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
26 NORIZAH BINTI RASDI 631121-08-5938 104A, Jalan SM1A/4, 012-5742154
32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
27 NUR FATIN ATIRAH BINTI 020603-08-1240 104A, Jalan SM1A/4, 012-5742154
ANUAR 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
28 MOHAMAD FAUZI BIN 890305-08-6341 104A, Jalan SM1A/4, 012-5742154
SAIDIN 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
29 SYED NAZZAROL SHAH 790704-08-5145 104A, Jalan SM1A/4, 012-5742154
 BIN SYED CHEAR 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
30 MOHD ADAM BIN IDRIS 871216-08-5335 104A, Jalan SM1A/4, 012-5742154
32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
31 SITI NOR LELA BINTI 860428-38-5678 104A, Jalan SM1A/4, 012-5742154
MAZUKI 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
32 ZURINDA BINTI ZAINI 781025-08-5088 104A, Jalan SM1A/4, 012-5742154
32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
33 HARLINA BINTI MOHD 800623-08-5430 104A, Jalan SM1A/4, 012-5742154
YUSOF 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
34 SUHANA BINTI 810603-08-6064 104A, Jalan SM1A/4, 012-5742154
IDERUS@IDRIS 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
35 JAMALIAH BINTI ABD 640410-06-5604 104A, Jalan SM1A/4, 012-5742154
RASHID 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
36 SITI NUR ALIYA BINTI 990819-08-5256 104A, Jalan SM1A/4, 012-5742154
SHAARI 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
37 NOR ARIZA BIN RAMLI 820215-08-6280 104A, Jalan SM1A/4, 012-5742154
32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
38 NURUL IMAN BINTI MAT 110525-08-1008 104A, Jalan SM1A/4, 012-5742154
SIHAT 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
39 MAIZATUL FARHA BINTI 890218-08-5412 104A, Jalan SM1A/4, 012-5742154
ABU BAKAR 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.
40 RABIYATUL AZURA BINTI 810814-08-5686 104A, Jalan SM1A/4, 012-5742154
ABU BAKAR 32040 SERI MANJUNG,
PERAK DARUL
RIDZUAN.

Keselamatan dan harta benda pelancong adalah dibawah

tanggungjawab Jurupandu Pelancong.