Pengetua/Guru Besar
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Tarikh :
Tuan/Puan,
2. *Anak/jagaan* saya.........................................................................................................................
nombor kad pengenalan ............................................................. dari *Tahun/Tingkatan* ....................
Kelas ................................ telah tidak hadir ke sekolah dari ..............................................................
hingga .................................................. ( ) hari kerana: …………………………………………………
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Yang Benar,
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Tandatangan Ibu Bapa/Penjaga
Nama: .............................................................
No KP: .............................................................