BORANG PERMOHONAN ANUGERAH KECEMERLANGAN PENDIDIKAN APPLICATION by KevinCrouthers

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									                  TAKAFUL IKHLAS SDN. BHD. (593075 U)
                  Business Operations
                  4th Floor, Bangunan Takaful IKHLAS, No 14, Jalan 19/1, 47300 Petaling Jaya, Selangor Darul Ehsan.
                  g/l: 03-7801 1488 fax: 03-7801 1388
                  website: www.takaful-ikhlas.com.my

                  (A subsidiary of MNRB Holdings Berhad)

                            BORANG PERMOHONAN ANUGERAH KECEMERLANGAN PENDIDIKAN
                               APPLICATION FORM FOR EDUCATION EXCELLENCE AWARD
   BAHAGIAN A : BUTIR-BUTIR PESERTA / PEMILIK SIJIL / DETAILS OF PARTICIPANT / CERTIFICATE OWNER
No. Sijil                                                                                                      Tarikh
Certificate No.                                                                                                Date
Nama Peserta
Participant’s Name


Nama Pemilik Sijil
Certificate Owner’s Name



Cek hendaklah dihantar ke                Cawangan TISB                                                      Pejabat Pengurus Ejensi
Cheque to be sent to                     TISB’s Branch                                                      Agency Manager Office
                                         Peserta                                                            Pejabat Pengurus Unit
                                         Participant                                                        Unit Manager Office
                                         Ambil Sendiri
                                         By Hand Collection


Sila tandakan (√) dan nyatakan jumlah ‘A’ yang diperolehi di dalam peperiksaan yang diambil. Slip atau sijil keputusan peperiksaan
yang telah disahkan hendaklah diserahkan bersama borang ini.

Please tick (√) and state the number of ‘A’s achieved in the examination. The certified examination result slip or certificate must be
submitted together with this form.


       UPSR                 A (minimum 5A)                                          Unified Examination Certificate (Junior)          _A (minimum 7A)


       PMR                  A (minimum 7A)                                          Unified Examination Certificate (Senior)          _A (minimum 7A)


       SPM/SPVM ________A (minimum 7A)


Tahun peperiksaan yang diambil / Year of examination sat : ____________________________




Tandatangan Pemilik Sijil / Signature of Certificate Owner
Tarikh / Date :

                               Untuk Kegunaan Ibu Pejabat / For Completion by Head Office

Senarai Semak / Checklist                                                                                                             Met   Not Met
Tarikh Kuatkuasa
Effective Date
Status Sijil
Certificate Status
Tarikh Bayaran Berikutnya
Next Due Date
Keputusan Peperiksaan        (UPSR – 5A / PMR – 7A / SPM – 7A)
Examination Result
Tempoh Sijil
Duration of Certificate
Pengesahan Keputusan Peperiksaan telah dibuat
Certified True Copy of Examination Result available

Diproses Oleh :
Processed By

Tarikh :
Date
                                                                                                                                            PSD-EEA (1208)

								
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