SEKOLAH KEBANGSAAN SERI SITIAWAN

MANJUNG RAYA,
32040, SERI MANJUNG, PERAK.

LEMBAGA DISIPLIN
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BORANG ADUAN/ SALAH LAKU MURID NO KES:

NAMA : _____________________________________________________
KELAS : _____________________________________________________
TARIKH : _____________________________________________________

Mengaku dan memahami dengan sebenar-benarnya tanpa paksaan dari mana-mana pihak,
telah melakukan/menyaksikan/ mengetahui salah laku seperti di bawah:

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Tandatangan Murid Tandatangan Guru

Nama Guru: …………………………………………