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AKUAN PENGURUS PASUKAN DAN SETIAUSAHA AGUNG MSSM NEGERI / KETUA UNIT SUKAN JPN
BORANG PENDAFTARAN INDIVIDU
P PERMAINAN : KEJOHANAN BOLING TENPIN MSS SABAH
NEGERI : SABAH
JANTINA : PEREMPUAN KUMPULAN UMUR: BAWAH 18 TAHUN
M01
Nama Pemain : HARIZAH NADHIRAH BINTI MOHD AZMI __________
Alamat Pemain : KG MUHIBBAH TENGAH, PEKAN BUKIT GARAM, KINABATANGAN, SABAH.
(Alamat Rumah)
No. Kad Pengenalan : 060814-12-0322 No. Telefon (Rumah): -
Tarikh Daftar / Daftar semula ke Sekolah : No. Daftar Sekolah :
No. Angka Giliran PMR/SPM : _____________________________ Tingkatan : 5 (LIMA)
Sediakan 2 keping gambar
ukuran pasport,
1 keping lekatkan di sini
AKUAN KEBENARAN IBUBAPA / PENJAGA
Nama IbuBapa / penjaga : MOHD AZMI BIN DULLAH No. KP : 770823-12-5359
No. Telefon (Pejabat) : - No. Telefon bimbit : 019-8625486
Saya bapa / penjaga kepada pelajar di atas mengesahkan segala keterangan di atas adalah benar dan gambar terbaru adalah betul. Saya juga
membenarkan anak / jagaan saya didaftarkan sebagai pemain Boling Tenpin Bawah 18 Tahun MSS Sabah untuk pasukan MSSD Kinabatangan
dan bersetuju mematuhi Perlembagaan, undang-undang, peraturan-peraturan, Pekeliling-pekeliling dan syarat-syarat mengenai pertandingan ini. Saya juga
faham bahawa pihak tuan sentiasa memberikan segala penerangan dan akan mengambil langkah-langkah keselamatan dan pengawasan yang diperlukan
sepanjang masa kejohanan tersebut.
Tandatangan : Tarikh :
AKUAN PENGETUA / GURU PENOLONG KANAN
Nama Pengetua / Guru Penolong Kanan : No. Telefon Sekolah :
Alamat Sekolah :
Saya mengesahkan segala keterangan di atas adalah betul dan gambar di atas adalah terbaru dan benar
(Tandatangan dan Cop Rasmi) Tarikh
Nama :
No. KP :
Diakui penama di atas adalah ahli pasukan ini yang menyertai Kejohanan/Pertandingan Majlis Sukan Sekolah-Sekolah Malaysia
dan sepanjang pengetahuan saya semua maklumat yang diberi adalah benar.
Pengurus Pasukan Setiausaha Agung MSSM Negeri / Ketua Unit Sukan Negeri
Nama :
No. KP : Cop Rasmi
Jawatan:
Tarikh : Tarikh :

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borang-m01.doc

  • 1. AKUAN PENGURUS PASUKAN DAN SETIAUSAHA AGUNG MSSM NEGERI / KETUA UNIT SUKAN JPN BORANG PENDAFTARAN INDIVIDU P PERMAINAN : KEJOHANAN BOLING TENPIN MSS SABAH NEGERI : SABAH JANTINA : PEREMPUAN KUMPULAN UMUR: BAWAH 18 TAHUN M01 Nama Pemain : HARIZAH NADHIRAH BINTI MOHD AZMI __________ Alamat Pemain : KG MUHIBBAH TENGAH, PEKAN BUKIT GARAM, KINABATANGAN, SABAH. (Alamat Rumah) No. Kad Pengenalan : 060814-12-0322 No. Telefon (Rumah): - Tarikh Daftar / Daftar semula ke Sekolah : No. Daftar Sekolah : No. Angka Giliran PMR/SPM : _____________________________ Tingkatan : 5 (LIMA) Sediakan 2 keping gambar ukuran pasport, 1 keping lekatkan di sini AKUAN KEBENARAN IBUBAPA / PENJAGA Nama IbuBapa / penjaga : MOHD AZMI BIN DULLAH No. KP : 770823-12-5359 No. Telefon (Pejabat) : - No. Telefon bimbit : 019-8625486 Saya bapa / penjaga kepada pelajar di atas mengesahkan segala keterangan di atas adalah benar dan gambar terbaru adalah betul. Saya juga membenarkan anak / jagaan saya didaftarkan sebagai pemain Boling Tenpin Bawah 18 Tahun MSS Sabah untuk pasukan MSSD Kinabatangan dan bersetuju mematuhi Perlembagaan, undang-undang, peraturan-peraturan, Pekeliling-pekeliling dan syarat-syarat mengenai pertandingan ini. Saya juga faham bahawa pihak tuan sentiasa memberikan segala penerangan dan akan mengambil langkah-langkah keselamatan dan pengawasan yang diperlukan sepanjang masa kejohanan tersebut. Tandatangan : Tarikh : AKUAN PENGETUA / GURU PENOLONG KANAN Nama Pengetua / Guru Penolong Kanan : No. Telefon Sekolah : Alamat Sekolah : Saya mengesahkan segala keterangan di atas adalah betul dan gambar di atas adalah terbaru dan benar (Tandatangan dan Cop Rasmi) Tarikh Nama : No. KP : Diakui penama di atas adalah ahli pasukan ini yang menyertai Kejohanan/Pertandingan Majlis Sukan Sekolah-Sekolah Malaysia dan sepanjang pengetahuan saya semua maklumat yang diberi adalah benar. Pengurus Pasukan Setiausaha Agung MSSM Negeri / Ketua Unit Sukan Negeri Nama : No. KP : Cop Rasmi Jawatan: Tarikh : Tarikh :