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                  BORANG PENGADUAN SALAHLAKU KAKITANGAN
                         COMPLAINT FORM ON PERSON


1.0 Butir-butir pegawai yang diadu / Details of officer to be reported
   1.1 Nama / Name : ______________________________________________________
   1.2 Jawatan / Designation : _______________________________________________
   1.3 No kakitangan / Staff no : _____________________________________________
   1.4 Tempat bertugas / Place of duty : _______________________________________


2.0 Butir-butir kesalahan / Details of misconduct
   2.1 Tarikh / Date                          : ____________________
   2.2 Waktu / Time                           : ____________________
   2.3 Tempat kejadian / Location of misconduct : ________________________________
   2.4 Keterangan salahlaku / Explanation of misconduct :
       _____________________________________________________________________
       _____________________________________________________________________
       _____________________________________________________________________
       _____________________________________________________________________
       ____________________________________________________________________


3.0 Dokumen & maklumat sokongan / Supporting document & evidence
   3.1 Dokumen sokongan yang disertakan (sekiranya ada) /
       Supporting documents attached (if any)
       i.      _______________________________________________________________
       ii.     _______________________________________________________________
       iii.    _______________________________________________________________
       iv.     _______________________________________________________________


( Sila sertakan lampiran keterangan jika ruang tidak mencukupi / Please use additional paper
should the space provided is insufficient )
   3.2   Nama saksi yang melihat kejadian (sekiranya ada) / Name of witness (if any)
         i.       _______________________________________________________________
         ii.      _______________________________________________________________


4.0 Butir-butir pelapur / Details of complainant
   4.1   Name / Name              : ______________________________________________
   4.2   NRIC No. / Passport No. : ______________________________________________
   4.3   Jawatan/Designation      : ______________________________________________
   4.4   Alamat/Address           : ______________________________________________
         ___________________________________________________________________
         ___________________________________________________________________
   4.5   Tel : ________________________


Saya mengaku bahawa segala keterangan di atas adalah benar./ I certify that all details given
above are true.




Tandatangan / Signature : ____________________
Tarikh / Date           :

___________________________________________________________________________

Hantarkan aduan anda kepada/ Address your complaint to:

         The Chairman
         Remedial Grievance System
         c/o Deputy Rector (Student and Alumni Affairs)
         Level 4, Administration Block
         International Islamic University Malaysia
         Jalan Gombak, 53100 Kuala Lumpur



UNTUK KEGUNAAN PEJABAT / FOR OFFICE USE
No rujukan kes / Case reference No :
Tarikh terima / Date received :

				
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posted:9/5/2012
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