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1. NAMA: ANNISA ANASTASYA TAUFIQ
KELAS: X-1
1. look at this form and answer the questions.
Question:
a) What do you call this kind of form?
 This is a savings withdrawal ticket
b) What institution issued this form?
 The institution is TD Bank
c) Why did amalia have to fill out this form?
 Because she want to withdraw money from her account
and she have to fill out the form because it’s the bank’s
procedure
d) What would happen if she didn’t fill out this form?
 She would not be eligible to take any money
e) How much did amalia withdraw from her savings?
 She took USD 60.000 from her account.
f) When did amalia withdraw her money from the bank?
 Amalia withdraw her money from the bank on June 21,
2017.
2. find at least five diffrerent forms which you may use in your
daily life. What do you find in the foms? Fill in the blank
bubbles.
Types of forms
Competition form
Hospital form
Library member form
Exra Curricular form
Registration form

2. A form is a document (printed or electronic) with spaces in which we
can write or enter data.
There are many kinds of form serving different functions such as:
 Purchase form
 Older form
 Withdrawal slip
 Deposit slip
 Reservation form
 Medical form
LET’S LEARN MORE
3. discuss the following questions with your friends and your
teacher.
a).Have you ever filled in a form?
 Yes, i have ever filled a form.
b).What kind of form?
 The form is biodata form.
c).When did you fill it in?
 When I was enter first school like elementry school,
junior hight school adn senior hight school.
d).In what occasions do people commonly fill in a form?
 People commonly fill in a form when want to register
school, when withdraw the money, before want to get
hospital service, etc.
e).What do you fill in the form with?
 I fill in the form with the pen.
f).What is the function of a form?
 The function of a form are for collecting information,
distributing data and so can be reexamind later when we
need.
REMEMBER

3. CULTURE AWARENESS
Characteristics of form:
 Lee to write (people only write whwt is instructed in the space
provided. Generally, the space is limited).
 Clear instructions about information to be supplied.
 Uniformity (for a speacial purpose, each person will fill in a
similiar form).
 Information can be re-examined later. (usually, we can find a
space for one’s signature in a form. It is important to evaluate
the accuracy of the information provided).
 Simple tasks (form enable people to collect and distribute data
easily).
4. Complete the definitions with the words provided on the right.
a).Order form are used bye businesses or (1) companies as a
convient way of (2) taking orders costumers. They contain (3)
informatin about exactly how much a particular older will cost.
b).Feedback forms are documents used to maximize response in
unobtrusive and intuitive way form clients or (4) costumers.
The forms are used to provide feedback on performance, (5)
qualty and general opinions about an (6) organization.
c).Purchase forms are used to make legally binding purchase
agreements between the (7) sellers and the buyers. They
contain essential information such as the (8) cost of the
purchase, the terms of (9) payment and warranties.
d).Medical forms are used to keep (10) medical infomation about
a patient that is (11) under the care of a hospital or a doctor.
They also contain (12) documentation of a patient’s medical
history and care.
e).Reservation forms are an important type of document which
are used when a person wants to (13) reserve his place or

4. position at a (14) hotel rooms or an event. For example a
reservation for a plane seat, (15) place, a table in a restaurant,
etc.
WHAT TO SAY IT
RESPONDING
 What’s your name, sir?
 How do you spell your last
name?
 What is your first name?
 What is your last name?
 My name is Richard Burner.
 B-U-R-N-E-R Burner
 Richard.
 Burner.
ASKING ADDRESS OR PLACE
OF ORIGIN
RESPONDING
 Where are you from?
 Where do you live?
 What’s your address?
 I am from singkawang,
kalimantan.
 I live in surabaya
 435 Mawar Street,
Palangkaraya
ASKING OCCUPATIONS RESPONDING
 What do you do?
 What’s do you do?
 Where do you work?
 How long have you beem
working in a bank?
 I am a teacher.
 I repair cars.
 I work at universal Bank.
 I have been working in this
bank for 5 years.
ASKING CONTACT NUMBER RESPONDING
 What’s your phone number?
 What’s your phone number at
work?
 What’s your office phone
number?
 My number phone is 0812xx-
xxxx-xxxx
 The number is 0812xx-xxxx-
xxxx
 028-4xx-x
ASKING PLACE/DATE OF
BIRTH
RESPONDING
 Where were you born?
 When were you born?
 I was born in Kudes on 28th of
November 1975

5. ACT IT OUT
5. repeat these words after your teacher
 Withdraw some money
 Savings accounts
 Withdrawal slip
 Security guard
 Write the date
 Write the amount
 signature
6. listes to the dialogue and fill in the blanks.
Man : good morning, Ma’am. What can i do for you?
Women: good morning. I’d like to whithdraw some money from my
savings account. What should i do?
Man : all right. Would you please take a withdraw slip from the
desk near the (1) security guard$125,00
over there, please.
Woman : over there? Behind the security guard?
Man : yes, that’s right.
Woman : well, here you are. Whwt should i do now?
Man : first, write the date, the month and the year at the (2)
top right corner.
Woman : right corner. Okay. The date is third (3) of october
2016. is that right?
Man : that’s right. And then write in words the amount you
want to withdraw.
Woman : Hmm... one hundred and twenty-five dollars.
Man : good. Now write it below the amount.

6. Woman : one hundret twenty five dollars.
Man : right. Oh, don’t forget to put your (4) signature and (5)
complete nine at the bottom of the slip.
Woman : here you are. Danielle Bedfort.
Man : Mrs Danielle Bedfort. Would you like the money in
twenty dollar bills?
Woman : I’d prefer in ten dollar bills.
Man : okay. One hundred and twenty five dollars. Here you are.
7. listen to the dialogue again and fill in the form.
DANIELLE BEDFORR
409 Deerwood Street
Minneapolis, MN 43283
October 3, 2016
PAY TO THE
ORDER OF
ONE HUNDRED TWENTY FIVE DOLLARS
Metro Union Savings Bank
65 West avenue
Minneapolis, minnesota 3467
MEMO Signature
________________
________________ Mrs. Danielle Bedfort
$125,00

7. 8. repeat these words your teacher.
 Data
processing
 External
training
 Computer
analys
 Interested in
it
 Human
resources
 Feel exited
 Preliminary
interview
 Complete the
form
 Parking lot
 Training
course
 Your own
expenses
 Leading
companies
9. listen to the dialogue and fill in the blank. Afterwards, fill in
the form.
Man : good morning, Ms Randolph. My name is Batara Surya. I’m
from the data processing departement.
Woman: good morning, Mr surya. What can i do for you?
Man : this morning i saw information about an external training
course and i’m interested in it.
Woman : that’s good, Mr Surya. The human resource department is
looking for a senior computer analyst. This position is
open to any (1)employees in this company.
Man : oh, that’s (2)wonderful , Ms Randolph. I feel exited about
it.
Women : thank you, Mr. Surya. To be able to take the course, you
have to do a preliminary interview. Now, the first step is
to complete the form.

8. Man : okay, i’ll try my luck, then.
Woman: good, let me write your name on the form. Batara Surya
from the data processing department. Is your office in C
building, near the parking lot?
Man : yes, that’s correct. What’s the name of the organization
that conducts this training course, Miss?
Woman : Media Informatika Nusantara. This organization has been
certifed to conduct trainings by some leading companies
in Indonesia.
Man : Incridible. I think i’ll take the computer analyst course.
And may i know how much the course costs?
Woman : It’s $350, but this will be at your own (3)expend , Mr
Surya. The company doesn’t (4)pay the cost of this
course.
Man : I understand, Ms Randolph. And when does the course
start?
Women : It lasts for 6 month and start (5)at the begining of the
month .
Man : thank you for the information. Ms randolph.
Women : One moment, Mr Surya. What’s your office number?
Man : It’s 22-86-70 extension 4.
Woman : thank you, Mr Surya and god luck.
EXTERNSL TRAINING INFORMATION FORM
Employee name BataraSurya
Department name The data processing department
Phone extension 22-86-70-4

9. Building C building
Training organization Media Informatika Nusantara
Course name the computer analyst course
Course cost $350
Course start at the begining of the month
Course lenght It lasts for 6 month
Please send a copy of the course description for the external course you
are attending. This will then be recorded into your employee file
LINK IT TO
10. Observe this deposit slip and answer the questions.
Questions:
a).Which bank issued this deposit slip?
 BOFI federal bank
b).Is the deposit in cash or by cheque? How do you know?
 The deposit by cheque, how do i know? Because the
object viewed on the slip
c).How much is the amount?
 $537.69
d).When was the slip printed?
 August 19, 2013
11. observe this form and choose the best answer from a, b, c,
and d.
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1. Why did intan complete this form?
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