LP/Am 30 Pin.

1/2018

LEMBAGA PEPERIKSAAN
KEMENTERIAN PENDIDIKAN MALAYSIA

KES SALAH LAKU - LAPORAN KETUA PENGAWAS

PEPERIKSAAN TAHUN

MATA PELAJARAN KOD KERTAS

TARIKH PEPERIKSAAN MASA PEPERIKSAAN

ANGKA GILIRAN NOMBOR KP/ MYKID

NOMBOR TELEFON CALON

KES SALAH LAKU MENIRU MENYAMAR MENYELUDUP MENDAPAT LAIN-LAIN

NOTA BANTUAN
(Tandakan (√) jika berkenaan)

DOKUMEN SOKONGAN

PELAPORAN KES SALAH LAKU:

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NAMA DAN TANDATANGAN KETUA PENGAWAS NAMA DAN TANDATANGAN PENGAWAS

NO KP: ....................................................................... NO KP: .......................................................................

NO. TELEFON: .......................................................... NO. TELEFON: ..........................................................

TARIKH: .................................................................... TARIKH: ....................................................................

DOKUMEN YANG PERLU DISERTAKAN

1. LP/ Am 31 Pin.1/2017 5. Borang Pengakuan Calon Pada Jadual Waktu

2. Bahan bukti yang asal (Nota/ Buku/ Keratan Akhbar dll) 6. Salinan Mykid/ Kad pengenalan yang disahkan
oleh Guru Besar/Pengetua/Ketua Pengawas
3. Pelan tempat duduk calon di dewan/ bilik peperiksaan
7. Cap Ibu Jari (kiri dan kanan) Penyamar
4. Laporan Pengawas (jika berkaitan) kiri kanan

PELAPORAN KES SALAH LAKU:

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..................................................................................... .....................................................................................
( ) ( )

NAMA DAN TANDATANGAN KETUA PENGAWAS NAMA DAN TANDATANGAN PENGAWAS

NO KP: ....................................................................... NO KP: .......................................................................

NO. TELEFON: .......................................................... NO. TELEFON: ..........................................................

TARIKH: .................................................................... TARIKH: ....................................................................

DOKUMEN YANG PERLU DISERTAKAN

1. LP/ Am 31 Pin. 1/2017 5. Borang Pengakuan Calon Pada Jadual Waktu

2. Bahan bukti yang asal (Nota/ Buku/ Keratan Akhbar dll)
3. Pelan tempat duduk calon di dewan/ bilik peperiksaan
4. Laporan Pengawas (jika berkaitan)
6. Salinan Mykid/ Kad pengenalan yang disahkan
oleh Guru Besar/Pengetua/Ketua Pengawas
7. Cap Ibu Jari (kiri dan kanan) Penyamar
kiri kanan