LEMBAGA PEPERIKSAAN

KEMENTERIAN PENDIDIKAN MALAYSIA

PERNYATAAN PENDAFTARAN PEPERIKSAAN
UJIAN PENCAPAIAN SEKOLAH RENDAH
TAHUN : .............

NAMA SEKOLAH
ANGKA GILIRAN
NAMA CALON
NO. PENGENALAN DIRI

: ....................................................................................................
: ....................................................................................................
: ....................................................................................................
: ....................................................................................................

MATA PELAJARAN YANG DIDAFTAR

1.
2.
3.
4.
5.
6.
7.
8.

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JUMLAH MATA PELAJARAN :

__________________________________
TANDATANGAN CALON

__________________________________
TANDATANGAN IBUBAPA/PENJAGA

LEMBAGA PEPERIKSAAN
KEMENTERIAN PENDIDIKAN MALAYSIA
PERNYATAAN PENDAFTARAN PEPERIKSAAN
UJIAN PENCAPAIAN SEKOLAH RENDAH
TAHUN : .............

NAMA SEKOLAH
ANGKA GILIRAN
NAMA CALON
NO. PENGENALAN DIRI

: ....................................................................................................
: ....................................................................................................
: ....................................................................................................
: ....................................................................................................

MATA PELAJARAN YANG DIDAFTAR

1.
2.
3.
4.
5.
6.
7.
8.

..............................................................................
..............................................................................
..............................................................................
..............................................................................
..............................................................................
..............................................................................
..............................................................................
..............................................................................

JUMLAH MATA PELAJARAN :

__________________________________
TANDATANGAN CALON

__________________________________
TANDATANGAN IBUBAPA/PENJAGA