Borang 2 (Form 2) JLKN /P/:02/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 BAGI PEMBAHARUAN PERAKUAN PEMBAHARUAN PENANGGUHAN (Peraturan 4) (APPLICATION FOR RENEWAL OF POSTPONEMENT CERTIFICATE) (Regulation 4) *(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 kadpengenalan(NRIC number):

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

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

Kod (Code)

:1

Keputusan(Decision)

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

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

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

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3. Butir-butir peribadi (Personal Particulars) a) Alamat tetap(Permanent address):

Poskod(Postcode): Negeri(State):

Bandar (City):

b) Alamat surat-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): .

4. Butir-butir tentang Program LatihanKhidmat Negara (Particulars relating to National Service Training) a) Nombor rujukan dan tarikh surat pemberitahuan (Reference number and date of notification letter): No. Rujukan(Reference No.): ..................................................................................................... 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)

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c) Nama kem untuk Latihan (Camp allocated for training): ..................................................................................................................................................

5. Butir-butir sebab memohon pembaharuan penangguhan. Sila tandakan( X ) di mana berkenaan dan kepilkan bersama dokumen sokongan yang berkaitan. (Particulars on the reason that cause for postponement renewal. Please mark ( X ) where appropriate and attach all relevant supporting documents.) a) Akan mendudukipeperiksaanutama (Will be sitting for a major examination) Masihberada di Tingkatan Lima danakan mengambil peperiksaan SPM pada tahun ini. (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. (Currently studying In Form Lower 6/Upper 6 and will be sitting for STPM examination this year/ next year.) Lain-lain. (Silanyatakan) : .. Others. (Please specify) : .........................................................................................................

b) Sedang meneruskan pengajian (Currently pursuing studies) Sedang meneruskan pengajian di mana-mana institusi pengajian tinggi IPTA / IPTS (Pursuing studies in any 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. (Silanyatakan) : .. Others, (Please specify) : ......................................................................................................... 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. (Silanyatakan) : .. Others.(Please specify) : .........................................................................................................

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6. Senarai dokumen sokongan (List of supporting documents) a) b) c) d)

7. Nama, alamat dan nombor telefon penyokong (Name, address and telephone numbers of referees)

Nama (Name) a)

Alamat (Address)

Rumah (House)

Bimbit (Handphone)

b)

......................................................................... Tandatangan pemohon(Applicants signature)

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

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Arahan untuk Borang 2 (JLKN /P/:02/Pin 2/10) 1. Isi borang dengan HANYA menggunakan huruf besar dan pen mata bola. Bagi memastikan pemprosesan segera permohonan tuan / puan, sila pastikan butir-butir adalah diisi dengan betul, tepat dan mudah dibaca. Permohonan yang mengandungi maklumat yang tidak tepat atau tidak boleh dibaca tidak akan dilayan. 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. Untuk meluluskan permohonan anda, sila pastikan Borang ini diisi dengan lengkap, ditandatangani dan dilampirkan dengan dokumen yang lengkap iaitu: 3.1. Bagi yang akan menduduki peperiksaan utama 3.1.1. 3.1.2. 3.2. Surat pengesahan rasmi daripada pihak sekolah, ATAU Surat pengesahan rasmi daripada Lembaga Peperiksaan Malaysia.

2.

3.

Bagi yang sedang meneruskan pengajian 3.2.1. Institusi Pengajian Tinggi Awam (IPTA) 3.2.1.1. 3.2.1.2. Salinan surat tawaran belajar daripada institusi pengajian tinggi yang dinyatakan tempoh pengajian, ATAU Surat rasmi mengesahkan bahawa pemohon sedang menghadiri kursus (sila nyatakan tempoh pengajian) daripada institusi pengajian tinggi

3.2.2.

Institusi Pengajian Tinggi Swasta (IPTS) 3.2.2.1. 3.2.2.2. 3.2.2.3. Salinan surat tawaran belajar daripada institusi pengajian tinggi yang dinyatakan tempoh pengajian, DAN Salinan resit pembayaran yuran pengajian (TERKINI) yang telah dibayar (sekurang-kurangnya daripada jumlah yuran sebenar). ATAU Salinan surat tawaran biasiswa. ATAU 3.2.2.4. Surat rasmi mengesahkan bahawa pemohon sedang menghadiri kursus (sila nyatakan tempoh pengajian) daripada institusi pengajian tinggi

3.3.

Apa-apa keadaan yang akan menimbulkan kesusahan luar biasa 3.3.1. Sedang hamil 3.3.1.1. Surat pengesahan rasmi daripada doktor. Lain-lain kesusahan luar biasa 3.3.2.1. Surat Sokongan yang jelas menyatakan kesusahan yang dialami oleh pelatih daripada Pesuruhjaya Sumpah, Majistret, Penghulu, Penggawa, Tok Sidang, Jaksa Pendamai, Komandan atau Pengetua Sekolah. DAN 3.3.2.2. Salinan dokumen sokongan.

3.3.2.

4.

Sekiranya permohonan pihak tuan / puan anda ditolak, anda boleh membuat rayuan kepada Majlis Latihan Khidmat Negara dengan menggunakan Borang 3 (JLKN/P/:03/Pin2/10). Rayuan itu bolehlah dialamatkan kepada:Majlis Latihan Khidmat Negara Kementerian Pertahanan Malaysia Aras 2-5, Bangunan Zetro Jalan 9/27C, Seksyen 5 Wangsa Maju 53300 Kuala Lumpur

5.

Untuk makluman lanjut, sila hubungi:Jabatan Latihan Khidmat Negara Kementerian Pertahanan Malaysia Aras 2-5, Bangunan Zetro Jalan 9/27C, Seksyen 5 Wangsa Maju 53300 Kuala Lumpur

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Instructions for Form 2 (JLKN/P/:02/Pin 2/10)

1.

Kindly fill up this application form using ONLY block letters and ball point pen. To ensure prompt process of your application, please make sure that all details filled up are correct, accurate and legible. The National Service Training Department reserves the right to reject application that is incomplete. 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. To expedite this application, please make sure that this form is filled upcompletely, signed by the applicant and enclosed with all the required documents: 3.1 For those that will be sitting for a major examination 3.1.1 3.1.2 3.2 A formal letter from the current school, OR A formal letter from the Examination Council of Malaysia.

2.

3.

For those who are pursuing studies 3.2.1 Higher Educational Institution (Public) 3.2.1.1 3.2.1.2 A copy of the Letter of Offer stating the duration of the course by the current Higher Educational Institution that the applicant is attending, OR A formal letter certifying that the applicant is attending the course (state the course duration) by the current Higher Educational Institution.

3.2.2

Higher Educational Institution (Private) 3.2.2.1 3.2.2.2 3.2.2.3 A copy of the Letter of Offer stating the duration of the course by the current Higher Educational Institution that the applicant is attending, AND A copy of the receipt (LATEST) proving payment of fees to the current Higher Educational Institution that the applicant is attending, OR A copy of the Scholarship Offer Letter proving that the course that the applicant is attending will be sponsored by a third party. OR 3.2.2.4 A formal letter certifying that the applicant is attending the course (state the course duration) by the current Higher Educational Institution.

3.3

Any other circumstances that will give rise to exceptional hardship 3.3.1 Currently pregnant 3.3.1.1 A formal confirmation letter from a doctor. Other exceptional hardship 3.3.2.1 A formal appeal letter certified by a Commissioner for Oath, Magistrate, Penghulu, Penggawa, TokSidang, Justice of Peace, Commandant or School Principal certifying that the applicant is undergoing that particular hardship. AND 3.3.2.2 A copy of any supporting documents proving that the applicant is undergoing that particular hardship.

3.3.2

4.

If your application is rejected, an appeal shall lie to the National Service Training Council by using form JLKN/P/:03/PIN 2/10. The appeal shall be addressed to :National Service Training Council Ministry of Defence Malaysia Aras 2-5, Bangunan Zetro Jalan 9/27C, Seksyen 5 Wangsa Maju 53300 Kuala Lumpur For further enquiries, please contact : National Service Training Department Ministry of Defence Malaysia Aras 2-5, Bangunan Zetro Jalan 9/27C, Seksyen 5 Wangsa Maju 53300 Kuala Lumpur

5.

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