3. Nombor Kad Pengenalan: (Baru) __________________
(Lama)
: __________________________
4. Kewarganegaraan :____________________________
Bangsa : _____________________________
|
5. Alamat Pejabat |
6. Alamat Rumah |
|
____________________________________ |
______________________________________ |
|
____________________________________ |
______________________________________ |
|
____________________________________ |
______________________________________ |
|
____________________________________ |
______________________________________ |
|
No. Tel :______________________ |
No. Tel :_______________________ |
7. Kelayakan Akedemik dan Professional
(Berikan butir-butir dengan tarikh):
_________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
8. Butir-butir Pengalaman Praktik, dengan tarikh :
__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
9.Rekod Kerjaya sebagai Juruukur : __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
10. Jenis Praktis :
__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
| |
| |
|
________________________ |
|
(Tandatangan
Pemohon) |
Nota : Semua salinan sijil dan kad
pengenalan yang disertakan bersama dengan borang permohonan ini hendaklah disahkan oleh Juruukur
tanah Berlesen dengan catitan seperti berikut :
"Salinan Yanh Diakui
Sah Daripada Salinan Asal"
*Bayaran Yuran : RM 50.00 -Tunai/Cek/Kiriman Wang (Potong mana yang tidak berkenaan)