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BORANG P.U.A.(275)

BORANG P.U.A.(275)

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Published by: En.Mat Lazim on Nov 30, 2009
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08/25/2015

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P.U.

(A) 275

JADUAL KETIGA
(Subperaturan 7(1)

PERATURAN-PERATURAN PENDIDIKAN
(PENERIMAAN MASUK KE SEKOLAH PEN!IMPANAN
DA"TAR DAN S!ARAT #AGI PENGEKALAN MURID DI SEKOLAH) 1$$%

PERMOHONAN UNTUK PERTUKARAN SEKOLAH
OLEH MURID &ARGANEGARA

Pengarah Pelajaran Negeri / PPD : __________________________________________________________________________

Nama dan alamat sekolah asal : __________________________________________________________________________

__________________________________________________________________________

#UTIRAN-#UTIRAN TENTANG PERTUKARAN
SEKOLAH


1 Nama !rid : ___________________________________________________________________________________

2 "antina : ___________________________________________________________________________________

# $arikh %ahir : ____________________ No. &ad Pengenalan / '!rat (eranak : _________________

) (angsa : ___________________________________________________________________________________

5
$arikh Penda*taran (sekolah
sekarang)
: ________________________________________________________________

+
Nama
,iasis-a
: ____________________ "!mlah ,iasis-a
:
________________________________

7 $ah!n terakhir / tingkatan tertinggi : ________________________________________________________________

.
"ika sekolah menengah/ aliran
(n0atakan)
: ________________________________________________________________

1 2 &el!l!san UP'3 : __________________________________________________________________________

P3 : __________________________________________________________________________

'P : __________________________________________________________________________


2 'ila lam4irkan sesalinan ke4!t!san
4e4eriksaan


15 Nama i,!/ ,a4a/ 4enjaga : __________________________________________________________________________

11 Alamat i,!/ ,a4a/ 4enjaga ( mengik!t !ndang6!ndang ) : __________________________________________

_____________________________________________________________________________________________________

12 Alamat s!rat men0!rat ( jika lain dari No. 11 ) : _____________________________________________________


_____________________________________________________________________________________________________
1# 'ekolah ,ar! 0ang di4ilih


Pilihan
Pertama
: ___________________________________________________________________________________


Piliham
&ed!a
: ___________________________________________________________________________________

1) 'e,a,6se,a, 4ert!karan : __________________________________________________________________________

15 $arikh 4ert!karan 0ang dikehendaki : ________________________________________________________________

1+ Ulasan 7!r! (esar ata! Penget!a : ________________________________________________________________

_____________________________________________________________________________________________________





$arikh : ____________________ ___________________________________________
( $andatangan 7!r! (esar ata! Penget!a )







Unt!k keg!anaan "a,atan Pelajaran Negeri / PPD : ________________________________________ 2 dil!l!skan /

tidak d!lil!skan !nt!k 4eneriamaan mas!k ke sekolah ______________________________________________________

_________________________________________
m!lai dari tarikh 0ang
di4ohon.


2 4otong jika tidak ,erkenaan.

8o4 3asmi


_____________________________________________
_
________________________________
$andatangan Pengarah Pelajaran Negeri /
PPD
$arikh


'ila sertakan dok!men A'A% DAN 'A%9NAN UN$U& P:N7:'A;AN :6

(i)
'ijil %ahir / '!rat (eranak
m!rid

(ii) '!rat Nikah / Perak!an 4enda*taran 4erkah-inan i,! ,a4a
(iii) &ad Pengenalan 9,!/ (a4a / Penjaga
(i<)
Pengesahan alamat ,ar! ((il a4i/ air / =!kai 4int! ) 0ang
terkini

(<) Perintah mahkamah tentang hak 4enjagaan/ jika i,! ,a4a ,er=erai / ,er4isah
(<i)
'!rat da*tar anak angkat mengik!t seks0en 25 A&$A Pengangkatan
1152


NOTA '

1 1 salinan dihantar ke4ada Pega-ai Pelajaran Daerah 0ang ,erkenaan
2 1 salinan ke4ada i,! ,a4a / 4enjaga
# 1 salinan !nt!k *ail sekolah lama

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