This document is a form listing the names of 30 students and the stationery and health items they received in 2014. It includes columns for student name, stationery items received (books, colored pencils, erasers, etc.), and health items received (toothbrush, toothpaste, towel, shampoo, soap, etc.). It is signed by Richie Royston bin Jasni, the coordinator of the program for 2014.

1. BORANG PENERIMAAN ALAT TULIS DAN BARANG KESIHATAN KEDAP 2014
NO NAMA
ALAT TULIS ALAT KESIHATAN
TANDATANGANbuku
latihan
pencil warna fail pembaris pemadam ubat
gigi
berus
gigi
tuala shampoo sabun
mandi
1 RUD SIP
2 IRENE SEBING
3 MARY OYOK
4 DINA KUJAN
5 REBICCA ERANG
6 ALAU PADA
7 BETINI LABANG
8 REJINA DI JUTANG
9 DORIS LIHAN
10 LILY TANGAN
11 RINAI MADUN
12 SARIMA NOH
13 WAN JOK
14 SILVIA INGAN
15 DIANA DING
16 RITA BULO

2. BORANG PENERIMAAN ALAT TULIS DAN BARANG KESIHATAN KEDAP 2014
17 KIONG PAREN
18 PUYANG WAN
19 BILONG WAN
20 SEDIN TURAN
21 ROSENA KAJAN
22 YAYA TANGAN
23 LUCY WAN
24 SARINA PADAN
25 REGINA SEGERAN
26 BUNGA BESENA
27 SEMION TAJA
28 MOLLY BESENA
29 LANGGUP AWIT
30 BAWIE NGOK
Disediakan oleh:
________________
RICHIE ROYSTON BIN JASNI
PENYELARAS KEDAP SESI 2014