PIA 1/21

BORANG PERMOHONAN PROJEK PEMBANGUNAN INTEGRASI AKUAKULTUR

LEKATKAN
GAMBAR
DISINI

Senarai semak:
Borang Permohonan Lengkap

Surat Rasmi Permohonan

Rancangan Perniagaan

Sijil Pendaftaran Perniagaan

Surat Kelulusan Sewa/Pajak Tanah

Peta Lokasi Tapak Projek

2. BUTIR-BUTIR PEMOHON

A) INDIVIDU

1. Nama persendirian : __________________________________________________________________________________

2. No. Kad Pengenalan : __________________________________________________________________________________

3. Alamat Surat-menyurat : __________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

4. Negeri : ______________________ 5. Daerah :_________________________

6. Mukim : ______________________
7. Telefon 6.1. Rumah : ______________________
6.2. Pejabat : ______________________
6.3. T/ Bimbit : ______________________

B) SYARIKAT/ PERSATUAN/ KOPERASI

1. Nama : __________________________________________________________________________________
2. No. Pendaftaran : __________________________________________________________________________________
3. Alamat surat-menyurat : __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
4. Negeri : ______________________ 5. Daerah :_________________________
6. Mukim : ______________________
7. Telefon 7.1. Rumah : ______________________
7.2. Pejabat : ______________________
7.3. T/ Bimbit : ______________________

3. BUTIR-BUTIR PERUSAHAAN AKUAKULTUR

1. Jenis perusahaan : __________________________________________________________________________________

__________________________________________________________________________________

3. Alamat surat-menyurat : __________________________________________________________________________________

__________________________________________________________________________________
__________________________________________________________________________________

4. Negeri : ______________________ 5. Daerah :________________________

6. Mukim : ______________________

7. Alamat ladang : __________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

8. Punca Modal : i. Sendiri RM __________________

ii. Pinjaman Bank RM __________________

iii. Lain-lain RM __________________

9. Jumlah peruntukan/bantuan : ___________________________________________________________________

yang dipohon
10. Bantuan yang pernah : ___________________________________________________________________
diterima

11. Pengalaman dalam perusahaan Akuakultur (Ada/Tiada)

(Jika ada sila nyatakan butiran dan pengalaman diruangan di bawah)

i. Jenis Sistem : ___________________________________________________________________

ii. Jenis ternakan : ___________________________________________________________________

iii. Tempoh Projek : ___________________________________________________________________
 PIA 1/21

BORANG PERMOHONAN PROJEK PEMBANGUNAN INTEGRASI AKUAKULTUR

4. BUTIR-BUTIR KEMAHIRAN & PENGALAMAN

Kursus-kursus yang pernah disertai
JENIS ANJURAN TEMPOH

5. KERTAS CADANGAN PROJEK DISERTAKAN(ADA/TIADA)

6. AKUAN PEMOHON
Saya mengaku bahawa maklumat-maklumat yang dikemukakan ini adalah benar.Saya akan mematuhi peraturan-peraturan yang ditetapkan oleh
Jabatan Perikanan.
Nama :
Tandatangan Pemohon/ :
Cop syarikat
Tarikh :
7. ULASAN PEJABAT PERIKANAN DAERAH
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Disokong / Tidak Disokong

_____________________ ____________________________________
Tarikh : Tandatangan
Nama
Jawatan
8. PERAKUAN JAWATANKUASA PENILAIAN PERINGKAT NEGERI
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Disokong / Tidak Disokong

_____________________ ____________________________________
Tarikh : Tandatangan
Nama
Jawatan
9. KEPUTUSAN JAWATANKUASA TEKNIKAL PELAKSANAAN DAN KEMAJUAN PROJEK (JTPKP)
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Disokong / Tidak Disokong

_____________________ ____________________________________
Tarikh : Tandatangan
Nama
Jawatan
 LAMPIRAN 6 SPeKS 2/06

LAPORAN PEMANTAUAN PELAKSANAAN PROJEK AKUAKULTUR

A. KLASIFIKASI PROJEK
A. Inkubator Tahun
B. Percubaan & Demonstrasi Bulan

C. Bantuan Bencana

D. Zon Industri Akuakultur

E. Projek Khas

F. Pemulihan & Penstrukturan Semula

G. Pembangunan Komuniti Akuakultur

Agensi Peneraju _________________________________________________________________________

Agensi-agensi lain _________________________________________________________________________

B. MAKLUMAT PROJEK

1. Nama projek :________________________________________________________________________

2. Lokasi Projek :________________________________________________________________________

3. Jenis Projek :________________________________________________________________________

4. Jenis Pengeluaran :________________________________________________________________________

5. Tarikh Mula Projek 6. Keluasan kawasan

5.1 Mula dibangunkan :________________________ 6.1 Bilangan,saiz kolam/sangkar :________________________

5.2 Mula diusahakan :________________________

7. Bilangan peserta projek :________________________

8. Tarikh Mula Pengeluaran :________________________ 9. Hasil Pengeluaran :________________________

8.1 Jangkaan :________________________ 9.1 Jangkaan :________________________

8.2 Sebenar :________________________ 9.2 Kuantiti :________________________

10. Kos Pembangunan :________________________ 9.3 Nilai (RM) :________________________

Infrastruktur ________________________

11. Kos Pengeluaran :________________________ 12. Pendapatan Bersih :________________________

11.1 Dijangka :________________________

11.2 Sebenar :________________________

C. LAPORAN KEMAJUAN PRESTASI PROJEK

1. Laporan Kemajuan Fizikal

_______________________________________________________________________________________________________________________
2. Laporan Kemajuan Kewangan

_______________________________________________________________________________________________________________________
3. Status Semasa Projek

_______________________________________________________________________________________________________________________

D. ISU DAN MASALAH

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

E. ULASAN PEGAWAI /PASUKAN NAZIRAN

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

F. LAMPIRAN
Gambar-gambar keadaan projek semasa lawatan disertakan bersama

Pegawai Pelapor :________________________

Tandatangan :________________________

Tarikh Lawatan :________________________

Tarikh Laporan :________________________

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