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Borang Rayuan Penangguhan PLKN

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					                                                                                                                                  Borang 3 (Form 3)




                                         AKTA LATIHAN KHIDMAT NEGARA 2003
                                        (NATIONAL SERVICE TRANING ACT 2003)

 PERATURAN-PERATURAN LATIHAN KHIDMAT NEGARA (PENANGGUHAN TANGGUNGAN) 2004
    (NATIONAL SERVICE TRAINING (POSTPONEMENT OF LIABILITY) REGULATIONS) 2004

                                     RAYUAN UNTUK PERAKUAN PENANGGUHAN
                                                   (Peraturan 5)
                                     (APPEAL FOR POSPONEMENT CERTIFICATE)
                                                  (Regulation 5)


Ketua Pengarah
Jabatan Latihan Khidmat Negara
Kementerian Pertahanan Malaysia
Aras 8, Menara TH Selborn
153 Jalan Tun Razak
50400 Kuala Lumpur


1. Butir-butir peribadi (Personal particulars)—

    (a) Nama (Name):                                  :



    (b) Nombor kad pengenalan (NRIC Number):



    (c) Alamat tetap (Permanent address):




                                                                          Poskod (Postcode):

    (d) Alamat surat menyurat (Jika berbeza daripada alamat tetap) (Postal address (If different from
        permanent address)):




                                                                          Poskod (Postcode):

    (e) Nombor telefon (Telephone numbers):

         Rumah (House ):

         Bimbit (Handphone):

         Lain-lain (Others):


    (f) Alamat e-mel (E-mail address):.........................................................................................................

                                                                      1
2. Butir-butir permohonan yang ditolak (Particulars of refused application)—

     (a) Nombor rujukan dan tarikh surat penolakan pemohonan penangguhan (Reference number and
         date of refusal of the application for postponement letter):

         Rujukan (Reference): …………………….……………………………………………………..............

         Tarikh (Date):


     (b) Tarikh untuk melapor diri untuk latihan (Date to report for training):




     (c) Tempat untuk melapor diri untuk latihan (Place to report for training):

         …………………………………………………………………………………………………………………


3.       Butir-butir rayuan (Particulars of appeal)—

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




         ........................................................................   ………………………….
         Tandatangan pemohon (Applicant’s signature)                                  Tarikh (Date)



     Kegunaan rasmi (Official use)—


     Diterima oleh (Received by): …………………………………………………………………………………


     Tarikh diterima (Date received):


     Keputusan Majlis (Decision of the Council):………………………………………………………...……..

     Tarikh luput penangguhan (Jika rayuan dibenarkan) (Date of expire of postponement (If appeal
     allowed)):



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Description: Borang Rayuan Penangguhan PLKN
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