KOPERASI SEKOLAH MENENGAH KEBANGSAAN PUNCAK ALAM

KUALA SELANGOR BERHAD,

JALAN MAHKOTA IMPIAN 2/1, BANDAR PUNCAK ALAM,
42300, PUNCAK ALAM, SELANGOR

BORANG PERMOHONAN PENGAWAS KOPERASI

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KEGUNAAN PEJABAT
Tarikh didaftarkan : _________________ No Ahli :
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Nama Pemohon : ___________________________________________________________________________________

Kelas : ___________________________________________________________________________________

No Kad pengenalan : _______________________________________________________________________________

Alamat rumah : ___________________________________________________________________________________

No telefon ibubapa : _______________________________________________________________________________

Keputusan PBD Akhir Tahun 2021 : ___________________________________________________________________

Nyatakan sebab anda berminat sebagai pengawas koperasi :

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Nama guru pencadang : ______________________________________________________________________________

Tandatangan : ______________________________________________________________________________

Nama guru penyokong : ______________________________________________________________________________

Tandatangan : _______________________________________________________________________________

Tandatangan pemohon Tandatangan Ibubapa

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No kp : No kp :