TARIKH MULA MASUK DI SEKOLAH INI

(Date of Admission to School)

(Admission Registration Number)

KATEGORI DERMASISWA
NAMA / NAME

NOMBOR KEMASUKKAN

(Scholarship Category)
(Number Enrol)
BILANGAN

BILANGAN
JANTINA
(Gender)

BANGSA
(Race)
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
32 32
33 33
34 34
35 35
36 36
37 37
38 38
39 39
40 40
41 41
42 42
43 43
44 44
45 45
Kategori Dermasiswa A - Asrama (Hostel)
(Scholarship Category) B - Bayar (Fee)
E - Menerima Elaun (Receiving Allowance)
K - Kenderaan (Free Transport)

YP - Yuran Percuma (Non Fee Payer)

 9
8
7
6
5
4
3
2
1

43
42
41
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10

45
44
(Number Enrol)

UGAMA
(Religion)

NOMBOR SIJIL BERANAK

(Birth Certificate Number)

KAD PINTAR
Nombor
(Number)

(Identity Smart Card)

Warna
(Colour)

TARIKH LAHIR
(Date of Birth)

UMUR PADA 1 JANUARI TAHUN INI

(Age on 1st January of this year)

KERAKYATAN
(Citizenship)

JENIS DARAH
(Blood Type)

PENYAKIT YANG DIHIDAPI? Dan ALAHAN

UBAT-UBATAN
(Any illness or sickness? and any Allergic to any
medication?)

BILANGAN
9
8
7
6
5
4
3
2
1

43
42
41
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10

45
44
(Number Enrol)
 ALAMAT RUMAH DAN POSKOD IBU BAPA ATAU PENJAGA
NAMA IBU BAPA ATAU PENJAGA
(Home Address and Post Code of
(Name of Parent or Guardian)
Parent or Guardian)

(Number Enrol)
BILANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
 PEKERJAAN IBUBAPA ATAU PENJAGA
(Occupation of Parent or Guardian)
NOMBOR TELEFON
(Telephone Number) ALAMAT PEJABAT DAN POSKOD IBUBAPA ATAU PENJAGA
(Office Address and Post
Code of Parent or Guardian)

(Number Enrol)
BILANGAN
RUMAH PEJABAT TELEFON BIMBIT
(House) (Office) (Mobile phone)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
KETERANGAN PENJAGA YANG MUDAH DIHUBUNGI (JIKA BERLAKU KECEMASAN)
(Guardian's Detail in case of emergency)

(Number Enrol)
BILANGAN
NAMA ALAMAT NOMBOR TELEFON HUBUNGAN
(Name) (Address) (Telephone Number) (Relationship)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
 PASUKAN RUMAH
(House Team)

KEGIATAN LUAR / KO-KURIKULUM

(Extra Curriculum Activities / Co-Curriculum)

YATIM / KEHILANGAN IBU /

KEHILANGAN BAPA?
(Orphanage?)

NAMA SEKOLAH UGAMA

(Name of Ugama School)

KELAS DARJAH SEKOLAH UGAMA

(Class of Ugama School)

BILANGAN
9
8
7
6
5
4
3
2
1

43
42
41
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10

45
44
(Number Enrol)
MATA PELAJARAN PILIHAN
(Optional Subjects)

NAMA SEKOLAH YANG TERDAHULU

(Former Primary/Secondary School)

HARIBULAN PENGHABISAN
KEDATANGAN
(Last Date Attended School)

NOMBOR SIJIL BERHENTI SEKOLAH

(Leaving Certificate Number)

LAIN-LAIN HAL
OTHERS