MAJLIS DAERAH SRI AMAN

Peti Surat 78,

95007 Sri Aman, Sarawak.
Telefon: 083-322066/322072
Faksimili: 083-320829
Emel: sriamandc@gmail.com
Laman Web: https://sriamandc.sarawak.gov.my

APPLICATION FOR USAGE OF PARKING LOT / PUBLIC PLACE

(TEMPORARY PERMIT)
A. PARTICULAR OF APPLICANT

NAME IN FULL : …………………………………………………………………………………………………………..

I.C NUMBER : …………………………………………………………………………………………………………..

COMPANY NAME : …………………………………………………………………………………………………………..

ADDRESS : …………………………………………………………………………………………………………..

…………………………………………………………………………………………………………..

TEL. NO : …………………………………..... (OFFICE) ……………………………………………(H/P)

B. PARTICULAR

LOCALITY : …………………………………………………………………………………………………………..

NUMBER OF PARKING LOT : ………………………………………………………………………………….

SIZE OF CANOPY : …………………………………………………………………………………………………………..

DURATION APPLY : FROM …………………………………………… TO …………………………………………….

APPENDIX : (a) A copy of locality plan,

(b) A copy of picture showing the exact car park area to be use,
(c) ** Consent letter from shop owner if applicable

Date : ……………………………………………. …………………………………………….

(Signature Applicant & Chop)

C. FOR OFFICE PURPOSE ONLY

STATUS OF APPLICATION Check by : .............................................

Name :
Position :
APPROVED NOT APPROVED
Date :

Amount : ………………………………. Confirm by : .........................................

(Secretary of MDSA)
Receipt No. : …………………………................... Date :