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BORANG-PENANGGUHAN PLKN

BORANG-PENANGGUHAN PLKN

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Borang 1 (Form 1) JLKN /P/:01/Pin 2/10

AKTA LATIHAN KHIDMAT NEGARA 2003 (NATIONAL SERVICE TRAINING ACT 2003) PERATURAN-PERATURAN LATIHAN KHIDMAT NEGARA (PENANGGUHAN TANGGUNGAN) 2004 (NATIONAL SERVICE TRAINING (POSTPONEMENT OF LIABILITY) REGULATIONS 2004) PERMOHONAN BAGIPERAKUAN PENANGGUHAN (Peraturan 3) (APPLICATION FOR POSTPONEMENT OF LIABILITY/ POSTPONEMENT CERTIFICATE) (Regulation 3) *(Sila baca arahan di muka surat 5 dan 6sebelum mengisi borang ini) (Please read the instructions on page 5 and 6before filling up this form)

1. Nama(Name):

2. No kad pengenalan(NRIC number):

Kegunaan rasmi (Official use)— Diterima oleh (Received by) :.......................................................................................................

Tarikh diterima(Date received) :....................................................................................................... Siri (Series) Kumpulan (Group) :............../.................... :1 2 3

Kod (Code)

:1

2

3

Keputusan(Decision)

: Lulus (Approved) / Tidak Lulus (Not Approved)

.............................................. Ketua Pengarah (Director General) /bagi pihak Ketua Pengarah (on behalf of Director General)

............................. Tarikh (Date)

1/6

.... 4.): ....................................... Butir-butir peribadi(Personal Particulars) a) Alamat tetap(Permanent address): Poskod(Postcode): Negeri(State): Bandar (City): b) Alamatsurat-menyurat [Jika berbeza daripada di atas] (Postal address [If different from above]): Poskod(Postcode): Negeri(State): Bandar (City): c) Nombor telefon(Telephone numbers): Rumah (House): Bimbit (Handphone): Lain-lain (Others): d) Alamat e-mel(E-mail address): …………………………………………………………………………............................ Rujukan(Reference No............ Butir-butir tentang Program Latihan Khidmat Negara (Particulars relating to National Service Training) a) Nombor rujukan dan tarikh surat pemberitahuan(Reference number and date of notification letter): No.........3. Tarikh(Date): Hari (Date) Bulan (Month) Tahun (Year) b) Tarikh melapor diri untuk latihan: (Date to report for training) Tarikh(Date): Hari (Date) Bulan (Month) Tahun (Year) 2/6 .............

.......................................... (Please specify) : ................c) Nama kem untuk latihan(Camp allocated for training): .. Silatandakan( X ) di mana berkenaan dan kepilkan bersama dokumen sokongan yang berkaitan. (Particulars on the reason that cause for postponement...) Lain-lain............................................ Others...................................................... 5......... Butir-butir sebab memohon penangguhan.................. Others........ c) Keadaan yang akan menimbulkan kesusahan luar biasa(Circumstances that will give rise to exceptional hardships) Sedang hamil (Currently pregnant) Tarikh dijangka bersalin (Expected date of giving birth) : Hari : (Date) Bulan (Month) Tahun (Year) Lain-lain.......... (Sila nyatakan) : ……………………………………………………………………………........) a) Akan menduduki peperiksaan utama (Will be sitting for a major examination) Masihberada di Tingkatan Lima dan akan mengambil peperiksaan SPM pada tahun ini. b) Sedang meneruskan pengajian (Currently pursuing studies) Sedang meneruskan pengajian di mana-mana institusi pengajian tinggi (Pursuing studies inany higher educational institutions) Tarikh mula belajar (Date of commence) Tarikh dijangka tamat belajar (Expected date of completion) : Hari : (Date) : Hari : (Date) Bulan (Month) Bulan (Month) Tahun (Year) Tahun (Year) Lain-lain.............................................................. (Please specify) : .......... Please mark ( X ) where appropriate and attach all relevant supporting documents................. (Silanyatakan) : ……………………………………………………………………………..................... 3/6 ... (Please specify) : ............................................. (Currently studying In Form Lower 6/Upper 6 and will be sitting for STPM examination this year/ next year..................... (Sila nyatakan) : ……………………………………………………………………………......... Others.... (Currently studying in Form Five and will be sitting for SPM examination this year..........................................) Berada di Tingkatan Enam Bawah/Atas dan akan mengambil peperiksaan STPM pada tahun ini/ tahun hadapan.................................

.... alamat dan nombor telefon penyokong (Name..................... address and telephone numbers of referees) Nama (Name) a) Alamat (Address) Rumah (House) Bimbit (Handphone) b) .... Nama........... Tarikh(Date) 4/6 ....................... Tandatangan pemohon(Applicant’s signature) ..............6.. Senarai dokumen sokongan (List of supporting documents) a) b) c) d) ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… 7.............................

Seksyen 5 Wangsa Maju 53300 Kuala Lumpur 5/6 . 3. sila pastikan Borang ini diisi dengan lengkap.2. Bangunan Zetro Jalan 9/27C.2. Seksyen 5 Wangsa Maju 53300 Kuala Lumpur 5. Bangunan Zetro Jalan 9/27C.1.2.3.1. 3.2. Surat Sokongan yang jelas menyatakan kesusahan yang dialami oleh pelatih daripada Pesuruhjaya Sumpah. Permohonan yang mengandungi maklumat yang tidak tepat atau tidak boleh dibaca tidak akan dilayan. Surat pengesahan rasmi daripada doktor. Penggawa. ditandatangani dan dilampirkan dengan dokumen yang lengkap iaitu: 3.3. Salinan surat tawaran belajar daripada institusi pengajian tinggi yang dinyatakan tempoh pengajian. Salinan surat tawaran belajar daripada institusi pengajian tinggi yang dinyatakan tempoh pengajian. Komandan atau Pengetua Sekolah.1. 3. 3.Arahan untuk Borang 1 (JLKN /P/:01/Pin 2/10) 1. ATAU Surat rasmi mengesahkan bahawa pemohon sedang menghadiri kursus (sila nyatakan tempoh pengajian) daripada institusi pengajian tinggi. ATAU 3.2.2. Untuk meluluskan permohonan anda. Sekiranya permohonan pihak tuan / puan anda ditolak. ATAU Salinan surat tawaran biasiswa. tepat dan mudah dibaca.3. Bagi memastikan pemprosesan segera permohonan tuan / puan. Apa-apa keadaan yang akan menimbulkan kesusahan luar biasa 3. Semua permohonan bagi perakuan penangguhan hendaklah dibuat dalam masa sepuluh (10) hari selepas penyiaran perintah Menteri yang menghendaki peserta menjalani Latihan Khidmat Negara atau dalam tempoh masa yang dipanjangkan sebagaimana yang boleh dibenarkan oleh pihak berkuasa yang sepatutnya.2. Penghulu.2. DAN 3.1.2.1. Surat rasmi mengesahkan bahawa pemohon sedang menghadiri kursus (sila nyatakan tempoh pengajian) daripada institusi pengajian tinggi. Bagi yang sedang meneruskan pengajian 3.3. 2. Rayuan itu bolehlah dialamatkan kepada:Majlis Latihan Khidmat Negara Kementerian Pertahanan Malaysia Aras 2-5.1.1.1.1. sila hubungi:Jabatan Latihan Khidmat Negara Kementerian Pertahanan Malaysia Aras 2-5.3.3.2. 3.3. Salinan dokumen sokongan yang berkaitan. Institusi Pengajian Tinggi Awam (IPTA) 3.1. Isi borang dengan HANYAmenggunakan huruf besar dan pen mata bola. Majistret.1. Surat pengesahan rasmi daripada pihak sekolah.2.2. sila pastikan butir-butir adalah diisi dengan betul. Jaksa Pendamai.1.2. Sedang hamil 3. Institusi Pengajian Tinggi Swasta (IPTS) 3. ATAU Surat pengesahan rasmi daripada Lembaga Peperiksaan Malaysia. Bagi yang akan menduduki peperiksaan utama 3.2.2.4.2. anda boleh membuat rayuan kepada Majlis Latihan Khidmat Negara dengan menggunakan Borang 3 (JLKN/P/:03/Pin2/10). 3.2. Untuk makluman lanjut. Tok Sidang. Lain-lain kesusahan luar biasa 3.2.2. 3. 3.2.1. 3. 4. DAN Salinan resit pembayaran yuran pengajian (TERKINI) yang telah dibayar (sekurang-kurangnya ½ daripada jumlah yuran sebenar).2.

2 A copy of any supporting documents proving that the applicant is undergoing that particular hardship.1 For those that will be sitting for a major examination 3.1 Currently pregnant 3. If your application is rejected. OR 3. Commandant or School Principal certifying that the applicant is undergoing that particular hardship. To ensure prompt process of your application.2. All applications for a postponement certificate must be made within ten (10) days after the publication of the order of the Minister requiring participants to undergo national service training or within such extended time as the proper authority may allow. Bangunan Zetro Jalan 9/27C. please make sure that all details filled up are correct. 3. For further enquiries.2.2 3. Seksyen 5 Wangsa Maju 53300 Kuala Lumpur 5.2. To expedite this application. 3.3.1.2 4. For those who are pursuing studies 3. OR A formal letter certifying that the applicant is attending the course (state the course duration) by the current Higher Educational Institution.4 A formal letter certifying that the applicant is attending the course (state the course duration) by the current Higher Educational Institution.2.2 A formal letter from the current school. accurate and legible.2.2. AND 3.Instructions for Form 1 (JLKN/P/:01/Pin 2/10) 1.3 Any other circumstances that will give rise to exceptional hardship 3.2. Penghulu. OR A formal letter from the Examination Council of Malaysia 2. OR A copy of the Scholarship Offer Letter proving that the course that the applicant is attending will be sponsored by a third party.2.1.3 A copy of the Letter of Offer stating the duration of the course by the current Higher Educational Institution that the applicant is attending.3.1 3.3.2.1.1 3.3. 3. AND A copy of the receipt (LATEST) proving payment of fees to the current Higher Educational Institution that the applicant is attending.1.1 A formal appeal letter certified by a Commissioner for Oath. Tok Sidang. please contact :National Service Training Department Ministry of Defence Malaysia Aras 2-5.2.2. The appeal shall be addressed to :National Service Training Council Ministry of Defence Malaysia Aras 2-5.1 Higher Educational Institution (Public) 3. Magistrate.2. 3.2 3.3. signed by the applicant and enclosed with all the required documents: 3.2 A copy of the Letter of Offer stating the duration of the course by the current Higher Educational Institution that the applicant is attending. Kindly fill up this application form using ONLY block letters and ball point pen. The National Service Training Department reserves the right to reject application that is incomplete. an appeal shall lie to the National Service Training Council by using form JLKN/P/:03/PIN 2/10. Seksyen 5 Wangsa Maju 53300 Kuala Lumpur 6/6 .2. please make sure that this form is filled upcompletely.2 Higher Educational Institution (Private) 3.1. Bangunan Zetro Jalan 9/27C. Penggawa.1 A formal confirmation letter from a doctor Other exceptional hardship 3. Justice of Peace.2.1 3.

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