Gambar

Persatuan Karyawan Malaysia

No 71-1, Medan Setia 1, Plaza Damansara,
Bukit Damansara, 50490 Kuala Lumpur
Email : Karyawanmalaysia@gmail.com
Tel: 03-20925517 Fax: 03-20925053

BORANG KEAHLIAN/ MEMBERSHIP FORM

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Nama Penuh / Full Name : ..................................................................................................................................................

Nama Pena / Nickname :....................................................................................................................................................

Nama Kumpulan / Syarikat / Organisasi / Name Of Group :

…………………………………………………………………………………………………………….………….....................................................

Alamat / Address :……………………………………………………………………………………….………..................................................

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No Tel :………………………………………...............................E-Mail:………………………………………….…..…................................

No KP/NRIC No:………………………………………………...Tarikh Lahir / Date of Birth :…………………………………..….….………..

Warganegara / Nationality:……………………………………………………………………….…….….....................................................

Bidang Kerja / Jawatan / Main area of

Work:……………………………………………………………..…….….....................................................

Pengisytiharan / Declaration

Saya memohon menjadi ahli Persatuan ini dan akan mematuhi segala peraturan
I wish to join the above association and agree to abide by its rules and regulations.

Tandatangan / Signature:…………………………………………..………Tarikh/Date:……………………………………………………….….

UNTUK KEGUNAAN PEJABAT SAHAJA

NO. KEAHLIAN : ……………………… DI TERIMA OLEH : …………………………

DISAHKAN OLEH :……………………………

*Yuran Pendaftaran Ahli RM 20 dan Yuran Tahunan RM 30. Sila lampirkan gambar
berukuran passport dan salinan kad pengenalan.