*(Sila baca arahan di muka surat 5 dan 6 sebelum mengisi borang ini)
(Please read the instructions on page 5 and 6 before filling up this form)
1. Nama (Name):
Kumpulan (Group) :1 2 3
Kod (Code) :1 2 3
.............................................. .............................
Ketua Pengarah (Director General) Tarikh (Date)
/bagi pihak Ketua Pengarah
(on behalf of Director General)
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3. Butir-butir peribadi (Personal Particulars)
Negeri (State):
b) Alamat surat-menyurat [Jika berbeza daripada di atas] (Postal address [If different from above]):
Negeri (State):
Rumah (House):
Bimbit (Handphone):
Lain-lain (Others):
4. 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. Rujukan (Reference No.): .....................................................................................................
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c) Nama kem untuk latihan (Camp allocated for training):
..................................................................................................................................................
5. Butir-butir sebab memohon penangguhan. Sila tandakan ( X ) di mana berkenaan dan kepilkan
bersama dokumen sokongan yang berkaitan. (Particulars on the reason that cause for postponement.
Please mark ( X ) where appropriate and attach all relevant supporting documents.)
Masih berada di Tingkatan Lima dan akan 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.)
c) Keadaan yang akan menimbulkan kesusahan luar biasa (Circumstances that will give rise to
exceptional hardships)
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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)
a)
b)
......................................................................... ..............................
Tandatangan pemohon (Applicant’s signature) Tarikh (Date)
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Arahan untuk Borang 1 (JLKN /P/:01/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.
2. 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.
3. Untuk meluluskan permohonan anda, sila pastikan Borang ini diisi dengan lengkap, ditandatangani dan dilampirkan dengan dokumen
yang lengkap iaitu:
3.2.1.1. Salinan surat tawaran belajar daripada institusi pengajian tinggi yang dinyatakan tempoh pengajian dan disahkan
salinan sebenar, ATAU
3.2.1.2. Surat rasmi mengesahkan bahawa pemohon sedang menghadiri kursus (sila nyatakan tempoh pengajian)
daripada institusi pengajian tinggi.
3.2.2.1. Salinan surat tawaran belajar daripada institusi pengajian tinggi yang dinyatakan tempoh pengajian dan disahkan
salinan sebenar, DAN
3.2.2.2. Salinan resit pembayaran yuran pengajian (TERKINI) yang telah dibayar (sekurang-kurangnya ½ daripada
jumlah yuran sebenar) dan disahkan salinan sebenar, ATAU
3.2.2.3. Salinan surat tawaran biasiswa dan disahkan salinan sebenar.
ATAU
3.2.2.4. Surat rasmi mengesahkan bahawa pemohon sedang menghadiri kursus (sila nyatakan tempoh pengajian)
daripada institusi pengajian tinggi.
4. Salinan dokumen sokongan yang dikemukakan kepada Jabatan Latihan Khidmat Negara hendaklah disahkan salinan sebenar oleh
Pesuruhjaya Sumpah, Majistret, Penghulu, Penggawa, Tok Sidang, Jaksa Pendamai, Komandan atau Pengetua Sekolah.
5. 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:-
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Instructions for Form 1 (JLKN/P/:01/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.
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.
3. To expedite this application, please make sure that this form is filled up completely, signed by the applicant and enclosed with all the
required documents:
3.2.1.1 A certified copy of the Letter of Offer stating the duration of the course by the current Higher Educational
Institution that the applicant is attending, OR
3.2.1.2 A formal letter certifying that the applicant is attending the course (state the course duration) by the current
Higher Educational Institution.
3.2.2.1 A certified copy of the Letter of Offer stating the duration of the course by the current Higher Educational
Institution that the applicant is attending, AND
3.2.2.2 A certified copy of the receipt (LATEST) proving payment of fees to the current Higher Educational Institution that
the applicant is attending, OR
3.2.2.3 A certified 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
4. All documents submitted to the National Service Training Department must be certified true copies by a Commissioner for Oath, Magistrate,
Penghulu, Penggawa, Tok Sidang, Justice of Peace, Commandant or School Principal.
5. 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
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