Free Essay

Juju

In:

Submitted By izninasuha
Words 360
Pages 2
KWSP
4

KUMPULAN WANG SIMPANAN PEKERJA

PERMOHONAN PENAMAAN

PERCUMA

(A) MAKLUMAT AHLI
NAMA

ABAS

NOMBOR KAD
PENGENALAN BARU
NO. SIJIL KELAHIRAN/
SIJIL WARGANEGARA
/POLIS/TENTERA

650127
N O

ALAMAT
SURAT/MENYURAT

BIN

1 2 1

IBRAHIM

-0 8 -5 2 1 1
J L N

NOMBOR KAD
PENGENALAN LAMA

L E N G K U K

S R I

S I A N T A N

51
41200

POSKOD

NEGERI

ALAMAT EMEL

SELANGOR

017 -3912838

NO. TELEFON RUMAH

-

NO. TELEFON PEJABAT

NO. TELEFON BIMBIT

(B) MAKLUMAT PENAMAAN
Dengan ini saya seperti nama dan nombor pengenalan diri di atas menamakan individu yang disenaraikan di bawah sebagai penama.
BIL

NAMA PENAMA MENGIKUT DOKUMEN PENGENALAN DIRI

NO. KAD PENGENALAN/SIJIL
KELAHIRAN/PASSPORT/LAIN-LAIN

HUBUNGAN
DENGAN AHLI

BAHAGIAN /
PERATUSAN

1

FAZIDAH BINTI OTHMAN

2

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

3

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

4

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

5

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

6

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

651103065368

ISTERI

100%

0 1

Bilangan penama
(C) PERAKUAN AHLI
1.
2.

Saya mengaku bahawa maklumat penamaan yang tercatat di dalam borang penamaan ini adalah betul dan dibuat dengan kerelaan hati saya.
Saya bersetuju untuk memilih alamat surat-menyurat di dalam borang ini dikemaskini dan saya mengesahkan bahawa alamat ini adalah terkini, lengkap dan betul.
Ya
Tidak

3.

Saya bersetuju untuk memilih maklumat penamaan yang didaftarkan ini dipaparkan di dalam Penyata Tahunan Ahli dan apa-apa notis yang berkaitan dengan penamaan ini .
Saya faham bahawa pilihan ini adalah dibuat dengan kerelaan hati saya dan pihak KWSP tidak bertanggungjawab ke atas kebocoran maklumat ini sekiranya Penyata Tahunan
Ahli atau apa-apa notis yang berkaitan pilihan ini tidak diterima oleh saya atas apa jua sebab.
Ya

Tidak

Tarikh :

________________________________________________

(D) PENGESAHAN SAKSI
1.

Saya dengan ini mengesahkan kenyataan yang telah dibuat oleh ahli di dalam borang ini adalah benar dan cap ibu jarinya diturunkan di hadapan saya.
Tandatangan :

_________________________________________

Nama Penuh :

Alamat :

IZNI NASUHA BINTI ABAS
_________________________________________

No. Pengenalan Diri :

950323145810
_________________________________________

(E) UNTUK KEGUNAAN KWSP SAHAJA

SIANTAN 51, 41200 KLANG
________________________________________________
Tarikh :

________________________________________________

(F) PENGESAHAN CAP IBU JARI AHLI
CAP IBU JARI KIRI

NO. AHLI KWSP
MASA TERIMA

NO 121, JLN LENGKUK SRI
________________________________________________

CAP IBU JARI KANAN

__________________________________

(COP TARIKH TERIMA)
Maklumat penamaan ini boleh disemak melalui i-Akaun Ahli yang boleh didaftar di mana-mana Kios KWSP dan Kaunter KWSP

V20120801

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