Page 19 - SURAT SIARAN PELAKSANAAN EMK 2018 - JPNJ&BKEW

LAMPIRAN B

Pengetua/ Guru Besar

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PERMOHONAN PENGELUARAN WANG ELAUN MURID BERKEPERLUAN KHAS

1. Nama : .................................................................................................................................

2. Tahun/Tingkatan : .............................................................................................................
3. No. Kad Pengenalan/No Sijil Lahir : ..................................................................................

4. No Pendaftaran/Kad OKU : ...............................................................................................
5. Nama Bank : ........................................................................................................................

6. No. Akaun: ...........................................................................................................................
7. Nama Ibu/Bapa/Penjaga : ................................................................................................

8. No Kad Pengenalan Ibu/Bapa/Penjaga : .........................................................................
9. Jumlah yang diperlukan : RM ..............................................................................................

(Ringgit Malaysia : ..............................................................................................................)
10. Tujuan wang dikeluarkan :-

i. ................................................................................................... RM .................
ii. ................................................................................................... RM .................

iii. ................................................................................................... RM .................
JUMLAH RM

.

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Tandatangan Murid Tandatangan Ibu / Bapa / Penjaga

Tarikh:

Permohonan diluluskan/tidak diluluskan.
Buku Akaun mesti dikembalikan pada ..........................................

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Tarikh (Tandatangan Pengarah Kolej/Pengetua/Guru Besar)

* Sila gunakan pen berdakwat biru sahaja