BORANG PERMOHONAN KEAHLIAN

KELAB BOLA SEPAK TUNAS GEMILANG (No. 3915/2010)

2660(H) Kompleks Perniagaan Lahar Yooi,
13300 Tasek Gelugor, Seberang Perai.
Tel : 012-5947624 H/P : 016-4206269
e-mail : tunasgemilangfc@yahoo.com

T A N D A Y A N G BERKEN A A N
SILA SERT AK A N S ALIN A N K A D SERT AK A N
PERM O H O N A N : PEN G EN AL A N /SIJIL LAHIR
2 KEPIN G
KE AHLI A N B ARU
S AIZ B AJU S / M / L / XL / XXL
G A MB AR
PEMB AH ARU A N

A BUTIRAN PERIBADI NOMBOR KEAHLIAN

1. N A M A PENUH :

2. T ARIKH L AHIR 3. J A NTIN A 4. W AR G A NE G ARA 5. B A N G S A

6. UMUR : ____ T A HUN 7. N O KP/SIJIL LAHIR

8. ST ATUS PERK AH WIN A N : BERK AH WIN BUJ A N G

9. AL A M AT RU M A H : _______________________________________________________________

_______________________________________________________________

_______________________________________________________________

N O . TELEF O N : _____________________ N O . HP : ______________________

B BUTIRAN PEKERJAAN/PERSEKOLAHAN

10. PEKERJ A A N /SEK O L A H : _____________________________________________________

AL A M AT M AJIK A N /SEK O L A H : ___________________________________________________

 C KAEDAH PEMBAYARAN

S a y a se rt a k a n w a n g tu n a i b e rju ml a h RM _______ b a g i b a y a r a n p e n d a ft a r a n / p e m b a h a -
ru a n k e a hli a n K e l a b Bol a S e p a k Tu n a s G e mil a n g .

• P e m b a y a r a n b ol e h d ib u a t d i p e j a b a t K e l a b Bol a S e p a k Tu n a s G e mil a n g se p e rti m a n a

a l a m a t d i a t a s.

• Y ur a n p e n d a ft a r a n RM 30 (S e k a li s a h a j a )

• Y u a r a n b ul a n a n RM 10 (Untuk p e l a tih s a h a j a )

PEN G AKU A N :

S a y a y a n g m e n uru nk a n t a n d a t a n g a n d i b a w a h, d e n g a n ini m e n g a ku b a h a w a b utir-b utir

y a n g d ib e rik a n a d a l a h b e n a r d a n b e rse tuju m e nj a d i a hli KBT G se rt a m e m a tu hi sy a r a t-
sy a r a t k e a hli a n se p e rti y a n g d ip e ru ntuk a n d a l a m p e rl e m b a g a a n KBT G .

*P e m o h o n d i b a w a h u m ur 18 t a h u n p e rlu m e n g isi sur a t k e b e n a r a n w a ris.

Ta n d a t a n g a n Pe m ohon T a rikh

________________________ ________________
( )

KEGUNAAN PEJABAT :

Bor a n g ini d it e rim a p a d a : ____________________ O l e h : ______________________

Ju ml a h B a y a r a n : _______________________ N o . Re sit : _________________

P e rm o h o n a n d ilulusk a n / tid a k d ilulusk a n.

_____________________________ _______________________
Ta n d a Ta n g a n Pe g a w ai C o p R a smi
 KELAB BOLA SEPAK TUNAS GEMILANG (No. 3915/2010)
2660(H) Kompleks Perniagaan Lahar Yooi,
13300 Tasek Gelugor, Seberang Perai.
Tel : 012-5947624 H/P : 016-4206269
e-mail : tunasgemilangfc@yahoo.com

Surat Kebenaran Ibu Bapa / Penjaga / Waris

N a m a d a n Al a m a t I b u b a p a / P e nj a g a / W a ris

_____________________________________________
_____________________________________________
_____________________________________________

N o Te l e fo n : T a rikh :

Uruse ti a K e l a b Bol a S e p a k Tu n a s G e mil a n g

T a se k G e lu g or, S e b e r a n g P e r a i.

Tu a n

Kebenaran Untuk Menyertai Kelab Bola Sepak Tunas Gemilang

S a y a …………………………………………………… N o KP

I b u /B a p a /P e nj a g a k e p a d a …………………………………… m e m b e ri k e b e n a r a n a n a k /
j a g a a n s a y a m e n y e rt a i K e l a b Bol a Se p a k Tu n a s G e mil a n g .

2. S e su n g g u h ny a s a y a m e n g e t a h ui d a n f a h a m b a h a w a p ih a k p e n g urus a n k e l a b a k a n
m e n g a m b il l a n g k a h-l a n g k a h k e se l a m a t a n se m a s a a ktiviti l a tih a n d a n p e rt a n d in g a n y a n g
d ij a l a nk a n. N a m u n d e miki a n s a y a m e n g a ku ti d a k a k a n m e n g a m b il se b a r a n g tin d a k a n
u n d a n g-u n d a n g a t a u m a hk a m a h t e rh a d a p p ih a k a t a u w a kiln y a y a n g b e rk a it a n d e n g a n
a p a - a p a k e hil a n g a n h a rt a , k e m a l a n g a n, k e c a c a t a n a n g g o t a a t a u se b a r a n g k e c e d a r a a n
l a in t e rh a d a p a n a k /j a g a a n s a y a y a n g b e rl a ku d a l a m p e rj a l a n a n p e rg i d a n b a lik a t a u
se p a nj a n g pro gr a m y a n g d ij a l a nk a n.

3. S a y a ju g a m e m b e ri k e b e n a r a n k e p a d a p ih a k k e l a b / p e n g e l ol a / w a kiln y a m e m b e ri
r a w a t a n k e c e m a s a n a t a u p e rt ol o n g a n p e ru b a t a n k e p a d a a n a k /j a g a a n s a y a jik a d d a p a ti
p e rlu.

S e ki a n, t e rim a k a sih.

P e n g a ku a n d ib u a t ol e h : ………………………………. P e n g e s a h a n W a kil K e l a b
Nama : Ta n d a t a n g a n
N o KP :
T a rikh : ………………………………..