DIKELOLAKAN OLEH : RAKAN PROGRAM :
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1 DIKELOLAKAN OLEH : RAKAN PROGRAM : SENARAI SEMAK PERMOHONAN PENERAJU SKIL ILTIZAM (WANITA) Nama Pemohon : No. Kad Pengenalan : SILA PILIH ANTARA SATU KURSUS DI BAWAH DAN TANDAKAN DI KOTAK YANG BERKENAAN: Tajuk Kursus : CITY & GUILDS LEVEL 3 DIPLOMA IN BODY & SPA THERAPY : CITY & GUILDS LEVEL 3 DIPLOMA IN BEAUTY THERAPY Sila sertakan bersama Borang Permohonan SALINAN yang telah DISAHKAN bagi dokumen berikut: Tandakan ( / ) jika berkenaan Surat Akuan Pengesahan Pendapatan NOTA: Jika Bapa / Penjaga / Ibu tiada Penyata Gaji atau Pencen Nota: 1. Semua salinan dokumen hendaklah Disahkan Benar oleh Ahli Parlimen / ADUN / Jaksa Pendamai / Penghulu / Pengerusi JKKK / Pesuruhjaya Sumpah 2. Pastikan Borang Permohonan dan semua dokumen di sertakan bersama senarai semak ini. PERAKUAN PEMOHON Saya sahkan semua dokumen yang berkenaan disertakan. Tandatangan Pemohon : Tarikh : UNTUK PENGESAHAN PENYEDIA LATIHAN Lengkap Disemak Oleh : Tarikh : Tidak Lengkap
2 YAYASAN PENERAJU PENDIDIKAN BUMIPUTERA (YPPB) NO. PENDAFTARAN YPPB RZL/YPPB/W/ BORANG PERMOHONAN PENERAJU SKIL ILTIZAM (WANITA) Cop Rasmi ROZSALL BEAUTY ACADEMY Gambar Terbaru Pemohon Berukuran Pasport ARAHAN KEPADA PERMOHONAN Borang ini hendaklah diisi dengan lengkap menggunakan HURUF BESAR. Sila rujuk maklumat lanjut dalam borang Panduan Mengisi Borang Sila sertakan bersama salinan dokumen seperti tersenarai dalam Senarai Semak Permohonan. A. MAKLUMAT PEMOHON 1. Nama Pemohon ( seperti dalam Kad Pengenalan ) 2. Alamat Rumah 3. No. Telefon Rumah H/P 4. Tarikh Lahir Hari Bulan Tahun 5. No. Kad Pengenalan Keturunan 7. Jantina Lelaki Perempuan 3. Senarai Tanggungan Ibubapa / Penjaga (tanggungan di bawah 18 tahun) Nama Penuh Umur (Thn) Hubungan Anggaran Perbelanjaan Bulanan Sekolah / Institusi Pengajian Jumlah Bantuan Pelajaran (**Nota) ** Nota : Sekiranya pelajar ADA menerima Bantuan Pelajaran yang lain, sila nyatakan
3 B. LATARBELAKANG KELUARGA 1. BAPA / PENJAGA a. Nama b. No. Kad Pengenalan - - c. Pekerjaan d. Pendapatan Sebulan ( * Nota ) RM e. Nama & Alamat Majikan f. No Telefon Pejabat 2. IBU a. Nama b. No. Kad Pengenalan - - c. Pekerjaan d. Pendapatan Sebulan ( * Nota ) RM e. Nama & Alamat Majikan f. No Telefon Pejabat * Nota : Sila sertakan sesalinan Penyata Gaji yang telah disahkan. Sekiranya ibubapa/penjaga bekerja sendiri atau tidak mempunyai pekerjaan tetap, sila lengkapkan borang Surat Akuan Pengesahan Pendapatan 3. PENGAKUAN Kami mengaku dan mengesahkan bahawa semua keterangan di atas adalah betul dan benar. Pihak YPPB adalah berhak menarik balik ATAU menamatkan bantuan melalui PROGRAM PENERAJU SKIL ILTIZAM dengan serta-merta sekiranya didapati maklumat yang diberikan adalah palsu. ( Tandatangan Pemohon ) ( Tarikh )
4 UNTUK KEGUNAAN ROZSALL BEAUTY ACADEMY SAHAJA A. SEMAKAN DAN PENILAIAN 1. Permohonan Lengkap Permohonan Tidak Lengkap 2. Markah Penilaian Temuduga (%) 3. Tarikh : 4. Nyatakan ringkasan penilaian : ( Tarikh ) ( Tandatangan Pegawai Institusi & Cop Rasmi Jawatan) Nama : Jawatan :
5 ORGANISASI PENGELOLA : RAKAN PROGRAM : YAYASAN PENERAJU PENDIDIKAN BUMIPUTERA ROZSALL SDN BHD Tingkat 15-1, Mercu UEM Lot 5, 1st Floor, Block A Jalan Stesen Sentral 5, KL Sentral Damai Point, Off Jalan Damai KUALA LUMPUR KOTA KINABALU, SABAH Talian am: Tel: / Faks: Faks: SURAT AKUAN PENGESAHAN PENDAPATAN ( * NOTA : Untuk dilengkapkan oleh Ibu/Bapa/Penjaga yang tidak mempunyai Penyata Gaji / Pencen ) Saya No. Kad Pengenalan yang beralamat di Dengan ini sesungguhnya dan sebenarnya mengaku bahawa : Saya adalah Ibu / Bapa / Penjaga ( potong yang tidak berkenaan ) kepada ( nama pemohon ) dan saya bekerja/ atau penerima bantuan sebagai dan tidak mempunyai penyata pendapatan/slip gaji majikan dan dengan ini saya akui bahawa jumlah pendapatan bulanan saya adalah RM Dan saya membuat akuan ini dengan kepercayaan bahawa apa-apa yang tersebut di dalamnya adalah benar. Tandatangan Ibubapa / Penjaga Tarikh Nama : No. Kad Pengenalan : Di hadapan saya, Tandatangan dan Cop Rasmi Ahli Parlimen / ADUN / Jaksa Pendamai / Penghulu / Pengerusi JKKK / Pesuruhjaya Sumpah Nama : No.Kad Pengenalan :
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