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BORANG AKUAN SALAH LAKU DISIPLIN

TARIKH PENGAKUAN :____________________________________________________________________

NAMA PELAJAR :____________________________________________________________________

NO. K/P :____________________________________________________________________

TAHUN :_________________ BLOK / DORM :_____________________________

NAMA PROGRAM :____________________________________________________________________

NAMA GURU KELAS :____________________________________________________________________

PENGAKUAN SAYA SEPERTI BERIKUT:

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Tanda tangan pelajar ................................................ Tanda tangan warden/


Pensyarah ................................................
.
Nama penjaga ................................................ Nama warden/
pensyarah MOHD ALHAFEZ BIN MAZLAN
No. Tel. Penjaga ................................................

Alamat Penjaga ................................................ Disahkan oleh


................................................ (Pengarah/ TPSA)
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