ent300 - final project _fresh chicken farm
DESCRIPTION
.TRANSCRIPT
ETR 300ENTREPRENEURSHIP
"BUSINESS PLAN"
FRESH CHICKEN FARM
NAME OF PARTNERS:
1. MOHAMAD SHUKRY B. MAKSAH 20032305402. MUHAMMAD FAIRUZ B. JOHARI 20032317143. MUHD. NURFAIZ B. BAHARUDDIN 20032316344. AHMAD LUQMAN B.
MOHAMED SHAIHANI 2003230883
Prepared For:
EN MALIKI B IBRAHIM (FKE)„ EN HUSNY B BASIR (MEDEC)
DIPLOMA IN ELECTRICAL AND ELECTRONIC ENGINEERINGFACULTY OF ELECTRICAL ENGINEERING
DATE OF SUBMISSION13 OCTOBER 2005
i
TABLE OF CONTENTS PAGE
COVER LETTER
ACKNOWLEDGEMENTS
AGREEMENT OF BUSINESS
ORGANIZATION LOGO
1 - m
iv
v-vii
1
INTRODUCTION
1.1 EXECUTIVE SUMMARY
1.2 BUSINESS PLAN PURPOSE
1.3 BACKGROUND OF OWNERS
1.4 PARTNER'S PROFILE
3
4
5
6-9
ADMINISTRATION PLAN 10
2.0 INTRODUCTION TO THE ORGANIZATION
i. VISION
ii. OBJECTIVE
iii. BUSINESS ADDRESS
iv. LOCATION PLAN
v. TYPES OF BUILDING AND INFRASTRUCTURE
a) OFFICE LAYOUT
2.1 ORGANIZATION CHART OF FRESH CHICKEN FARM
2.2 LIST OF ADMINISTRATION PERSONNELS
2.3 SCHEDULE OF TASK AND RESPONSIBLITIES
2.4 SCHEDULE OF REMUNERATION
2.5 LIST OF OFFICE EQUIPMENTS AND SUPPLIES
2.6 ADMINISTRATION BUDGET OF FRESH CHICKEN FARM
11
12
13
14
15
16
17
18-20
20
21
22
MARKETING PLAN 23
3.0 INTRODUCTION 24
3.1 PRODUCT OR SERVICE DESCRIPTION
3.2 TARGET MARKET 25
3.3 MARKET SIZE
3.4 MAIN COMPETITORS 26
/. STRENGTHS OF COMPETITORS 27
ii. WEAKNESSS OF COMPETITORS
iii. STRENGTHS OF FRESH CHICKEN FARM
3.5 MARKET SHARE 28
3.6 SALES FORECAST 29 - 30
3.7 MARKETING STRATEGIES 31
i. PPRODUCT
ii. PRICING
iii. PLACE/DISTRIBUTION 32
iv. PROMOTIONS 33
3.8 MARKETING BUDGET 34
OPERATION PLAN 35
4.0 INTRODUCTION 36
4.1 FLOW CHART OF OPERATION ACTIVITIES 37
i. FLOW CHART CONVENTIONAL SYMBOLS 38
ii. PROCESS FLOW CHART 39
4.2 OPERATIONS SYSTEM
i. READY OF BOILER CLOSED HOUSE 40
ii. INSTALL THE NECESSARY BROODING EQUIPMENT
a. DRINKER SYSTEM 41
b. FEEDING SYSTEM 42
c. PAD COOLING SYSTEM 43
iii. CHICK PLACEMENT 44
iv. CHICK QUALITY
v. DAILY CONTROL AND QUALITY CONTROL
a. VENTILATION 45
b. FEED AND WATER 46
c. LIGHT 47
d. DISEASE CONTROL
e. BIO-SECURITY
vi. GROWING PHASE 48
a. UNIFORMITY
b. MODIFICATION OF FEED AND NUTRIENT INTAKE
c. LIGHTING PROGRAMS 49
vii. CATCHING PROCESS
viii. DISINFECTION 50
4.3 BUSINESS OPERATION TIME
4.4 CAPACITY PLANNING 51
4.5 TOTAL COST 52
4.6 MATERIAL REQUIREMENTS (INPUT)
4.7 LIST OF OPERATIONS PERSONNEL 53
4.8 SCHEDULE OF TASKS AND RESPONSIBILITIES
4.9 SCHEDULE OF REMUNERATION 54
4.10 MACHINE AND EQUIPMENT 55-57
i. INFRASTRUCTURE DEVELOPMENT
ii. EQUIPMENT AND MACHINERY
4.11 OPERATIONS SPACE LAYOUT PLAN 58
4.12 OPERATION OVERHEAD 59
4.13 OPERATION BUDGET 60
FINANCIAL PLAN 61
5.0 INTRODUCTION 62
i. OBJECTIVE 63
5.1 PROJECT IMPLEMENTATION COST SCHEDULE 64
5.2 SOURCE OF FINANCE SCHEDULE 65
5.3 SUPPORTING SCHEDULES 66
i. LOAN OF AMORTIZATION SCHEDULE
ii. FIXED ASSET DEPRECIATION SCHEDULE 67 - 71
5.4 PROFORMA FINANCIAL STATEMENTS
i. CASH FLOW PROFORMA (ANUALLY) 72 - 73
ii. PROFORMA PROFIT AND LOSS ACCOUNT FRESH 74
CHICKEN FARM
iii. PROFORMA BALANCE SHEET ACCOUNT FRESH 75
CHICKEN FARM
CONCLUSION / RECOMMENDATIONS 76 - 77
APPENDIXES 78
Diploma In Electrical and Electronic Engineering,
Faculty of Electrical Engineering,
Mara University of Technology,
Shah Alam Campus,
40450 Shah Alam,
Selangor.
En. Husny B. Basir
Lecturer of Fundamentals of Entrepreneurship (ETR 300)
MEDEC,Blok 13
Intekma Resort & Convention Centre (Level 4)
40450 Shah Alam
Selangor Darul Ehsan
Dear Sir,
Submission Of Business Plan
Referring to the matter above, Fresh Chicken Farm would like to submit the business
plan for your analysis and references. Fresh Chicken Farm would start our business with
partner and address mentioned below:-
Details of partners are as follows:-
1. Mohamad Shukry B. Maksah 2003230540
2. Muhammad Fairuz B. Johari 2003231714
3. Muhd. Nurfaiz B. Baharuddin 2003231634
4. Ahmad Luqman B. Mohamed Shaihani 2003230883
Business address:-
FRESH CHICKEN FARM
Lot 3307, Batu 7,
Lorong Sarkawi,
Jalan Kebun
42 450 Klang,
Selangor Darul Ehsan
We have tried our best to prepare this business plan with all data compiles for your good
judgments. This working paper is a group effort and all experiences gained are valuable
lesson for entire group members.
We hope that our business plan will satisfy your requirement for this subject (ETR 300). We
also hope that our business plan can give some benefit to other people especially as a
reference material for the future.
Yours sincerely,
(Mohamad Shukry B. Maksah)
General Manager
(Muhd. Nurfaiz B. Baharuddin)
Marketing Manager
lammad Fairuz B. Johari)
Operation Manager
(Ahmad Luqman B. Mohamed Shaihani)
Financial Manager
in
ACKNOWLEDGEMENT
We would like to thank ALLAH S.W.T for His blessings that we were able to
finish this assignment. We would also like to thank our lecturers, En Maliki and En
Husny for the guidance and lectures that have given us a clear view on how to document
our business plan.
In preparing the plan, we have also come across several individuals and
interviewed them for information gathering. We would like to extend our gratitude to
them particularly En Baharen and En Azaruddin because of their willingness to spend
their time in answering our questions regarding chicken business.
Last but not least, we would also like to thank our classmates who have helped us
in answering questions related to the business plan. Their generosity and assistance are
greatly appreciated.
IV
AGREEMENT OF BUSINESS
The agreement letter has been made on 28 July 2005 between 4 partners of the
company and below is the list of partners and the agreed terms.
Mohamad Shukry B. Maksah
850628-10-5221
41 Jin Sri Damak 50,
Taman Sri Andalas,
41200 Klang,
Selangor.
Muhd. Nurfaiz B. Baharuddin
850720-14-5883
167 Jin. Tun Abdul Razak,
Taman Sri Andalas,
41200 Klang,
Selangor.
Muhammad Fairuz Bin Johari
851107-07-5455
99 Jin. Sri Damak 22,
Taman Sri Andalas,
41200 Klang,
Selangor.
Ahmad Luqman B. Mohamed Shaihani
850515-10-5559
11 Jin. SriSedeli5,
Taman Sri Andalas,
41200 Klang
Selangor.
Partners of Fresh Chicken Farm have agreed to all the terms and conditions that have
been discussed and all the terms and conditions of the company are stated as below:
1. The partners have agreed with the name of the company Fresh Chicken Farm
and all businesses with the company should apply the mailing address as
below:
FRESH CHICKEN FARM
Lot 3307, Batu 7,
Lorong Sarkawi,
Jalan Kebun
42450 Klang,
Selangor Darul Ehsan
2. All partners agree with the reasonable salaries given to them.
3. Documents such as profit and loss statement, balance sheet and other confidential
documents shall not be revealed to others.
4. Every partner is entitled to participate in the management of the business.
5. Every partner knows of the risk and agrees that the liability for the company is
unlimited and we are ready to pay off all liabilities for the company with own
properties.
VI
Below are the signatures of all partners that have agreed with all the terms given above.
MOHAMAD SHUKRY B. MAKSAH
I/C: 850628-10-5221
MUHAMMAD FAIRUZ B. FOHARI
I/C: 851107-07-5455
MUHD. NURFAIZ B. BAHARUDDIN
I/C: 850720-14-5883
AHMAD LUQMAN B. MOHAMED SHAIHANI
I/C: 850515-10-5559
Vll
FRESH CHICKENFARM
DEFINITION OF THE LOGO
FRESH CHICKEN FARM | z ) Represent the name of our company.
CIRCLE SHAPE l~~> Represents unity between partners and all theemployees.
WHITE BIRDS
BLUE Hy
Represent our products
Represent the courage and hard work among thepartners and employees.
1.1 EXECUTIVES SUMMARY
This business is based on partnership where it consists of four (4) members.
The members consist of the General Manager, Administration Manager, Marketing
Manager, Operational Manager and Financial Manager. The business capital is
amounted to RM372,410 where the total contribution of each member is RM79,910
and the rest is from the Bank Pertanian loan.
FRESH CHICKEN FARM is a company related to the breeding the chicken
meat. Our market focus is for the Pertanian Pertiwi, a company that directly deals
with us, they will supply the day-old-chicks with the certain price and buy the chicken
back when it reach at certain age (normally at 50 days). For those who are interested
to buy the fresh chickens, we can't sell to them due to our contract with the Pertanian
Pertiwi.
Our business will be expected to commence on 2006 and our vision is to make
our company a well-known, established and satisfied by our customer in order to
expand our capacity of chickens and to attract other companies to deal with us with a
better price. This will be realized by the full cooperation and efforts among the
partners to promote this company.
Based on the objectives above, we are venturing into livestock industry.
Chickens' farming has the potential of being a profitable business if it's done in
modern way with large scale and systematically managed.
We will expect that our business will become more developed in the near
future because the demand for the chicken's meat is high and not many breeders use
the closed system. This will give more advantages for us to make our product more
profitable and stabile in the long run.
1.2 BUSINESS PLAN PURPOSE
The main purpose of this business plan is for the reference of several
audiences / parties such as:
1. The Entrepreneurs (Fresh Chicken Farm's managers).
To better understand the purpose of the business and act as guideline to
manage the business effectively and efficiently.
2. Financial Institutions.
Assist and help the financial institution to evaluate the capability of the
proposed project and provide loan for the business. Financial institution
involved in this business project is Bank Pertanian Malaysia.
3. Suppliers.
Help convince suppliers of the viability of our business venture thus benefiting
both the suppliers and our company in the long term business arrangement.
4. Company Staffs / Workers.
Help workers to understand the business's goals and objectives and give a
guideline to them regarding their job duties and responsibilities.
5. Customers.
Persuade and influence our customers regarding the products being offered
and gives assurance and confidence to them to have business with us.
13 BUSINESS BACKGROUND
Below is the business background for our company:-
Name of Business/Company : FRESH CHICKEN FARM
Address : Lot 3307, Batu 7,
Lorong Sarkawi,
Jalan Kebun,
42450 Klang,
Selangor Darul Ehsan.
Telephone : 03-31222372
Fax No. : 03-31222375
Form of Business
Main Activities
Date of Registration
Number of Registration
Date of Commencement
Initial Capital
Name of Bank
Account No.
: Partnership
: Providing services of breeding the chicken meat.
: In progress
: hi progress
: hi progress
: RM 79,910
: Bank Pertanian Malaysia
: 40950003456
1.4 PARTNER'S PROFILE
1. Name Mohamad Shukry B. Maksah
Identity Card Number
Permanent Address
Telephone No.
Date of Birth
Age
Marital Status
Academic Qualification
Courses Attended
Skills
Experience
Present Occupation
Previous Business
Experiences
: 850628-10-5221
: 41 Jin. Sri Damak 50, Taman Sri Andalas,
41200 Klang, Selangor.
: 019-3079070
:28 th June 1985
: 20 years old
: Single
: Diploma In Electrical Engineering
: Entrepreneurship
: Computer related
:None
: Undergraduate
:None
: None
2. Name Muhammad Fairuz B. Johari
Identity Card Number
Permanent Address
Telephone No.
Date of Birth
Age
Marital Status
Academic Qualification
Courses Attended
Skills
Experiences
Present Occupation
Previous Business
Experiences
: 851107-07-5455
: 99 Jin. Sri Damak 22, Taman Sri Andalas,
41200 Klang, Selangor.
: 017-3082892
:7 t h November 1985
: 20 years old
: Single
: Diploma In Electrical Engineering
: Entrepreneurship
:None
: None
: Undergraduate
: None
: None
3. Name Muhd. Nurfaiz B. Baharuddin
Identity Card Number
Permanent Address
Telephone No.
Date of Birth
Age
Marital Status
Academic Qualification
Courses Attended
Skills
Experiences
Present Occupation
Previous Business
Experiences
: 850720-14-5883
: 167, Jalan Tun Abdul Razak, Taman Sri
Andalas, 41200 Klang, Selangor.
: 012-6045320
: 20th July 1985
: 20 years old
: Single
: Diploma In Electrical Engineering
: Entrepreneurship
: None.
: None.
: Undergraduate
: None
:None
4. Name
Identity Card Number
Permanent Address
Telephone No
Date of Birth
Age
Marital Status
Academic Qualification
Courses Attended
Skills
Experiences
Present Occupation
Previous Business
Experiences
: Ahmad Luqman B. Mohamed Shaihani
: 850515-10-5559
: 11 Jin. Sri Sedeli 5, Taman Sri Andalas,
41200 Klang, Selangor.
: 012-9157455
: 15th May 1985
: 20 years old
: Single
: Diploma In Electrical Engineering
: Entrepreneurship
: None
: None
: Undergraduate
: None
:None
Fl
yj J 7J
10
2.0 INTRODUCTION TO THE ORGANIZATION
Administration plan is first step of business to become more developed and
expounded in the future. It is important in every business. The effectiveness of
FRESH CHICKEN FARM is based on the administration that has been planned
systematically and followed by the proper planning before the business is established.
The important things that have been taken care of are well organization and
effectiveness in administration plan.
Several things that are included in this part are;
> Organization planning
> Organization chart
> Numbers of workers/labor
> Administration budget
> Office layout
> Remuneration Table
> Workers intensive
^ Position, responsibilities and specific task
Vision
It is FRESH CHICKEN FARM to be strength and famous farm over the world
as a quality and fresh "chicken" provider in order to fulfill an increase of market
demand for this favorite chicken by the year 2015. FRESH CHICKEN FARM should
be promoted to other countries to our vision that our local favorite chicken is to meet
a satisfying among foreigners.
11
Objective
1) Justly to compensate the employees and owners of FRESH CHICKEN
FARM.
2) Contribute to the development and growth of the country's economy and to
increase the percentage of Bumiputera involves in business
3) To create productivity among employees
4) To provide the best quality of "chicken" every time in order to attract more
customers
Business Address
Our business will be situated at the following address:
FRESH CHICKEN FARM
Lot 3307, Batu 7,
Lorong Sarkawi,
Jalan Kebun
42 450 Klang,
Selangor Darul Ehsan
12
b) Location Plan
HOUSE AREA
LORONGAKTBAKSR"• FRESH •
• CHICKEN •
• FARM *
MARDI
JAUWKH
FROM KUA1A LUMPURKESAS HIGHWAY
-mrnmm
PROTONSERVICECENTER
FROM HAH ALAM
ECONSAVE
(AMPIINGJA^I
ESSO
TEMPLE
HOUSE AREA
Shell
PUUWMDAH
TESCO
BUWTTWGGJGIANT
KLANG
Hospital BesarKlang
13
Type of Building and Infrastructure
Among the facilities that are provided at our project site are:
1. Office
2. Toilet
We have chosen a project site which has all the necessary facilities and infrastructure
as a catalyst for the growth and development of our business, FRESH CHICKEN
FARM. Our business is situated only 45 minutes away from Kuala Lumpur through
KESAS highway.
Among the many infrastructures that can be found in the project site are:
a) An excellent highway system where it can facilitate the customers to frequent the
project site and buy our products. It will also make it more convenient for the
suppliers to come and supply the raw materials needed by our company.
b) Electricity power supply has already been provided by the Tenaga Nasional Berhad
along the Jalan Kebun.
c) Telephone line has already been made available by the Telekom Malaysia Berhad
and also water supply from the Water Department along Jalan Kebun.
14
OFFICE LAYOUT
D 1—*-* i—*—*—— i—
<
)
FINANCIALMANAGER
OPERATIONMANAGER
)GENERALMANAGER
t F ^DaMARKETINGMANAGER
KEYS:
Chair Sofa Telephone
BoardComputer Toilet White
Table
15
2.1 ORGANIZATION CHART OF FRESH CHICKEN FARM
ADMINISTRATIONMANAGER
GENERAL MANAGER
MARKETINGMANAGER
OPERATIONMANAGER
WORKERS
FINANCIALMANAGER
WORKERS
The style of the organization chart is designed on functional style. The
organization structure on functional style is very effective to the any company which
are need peculiar specialize.
16
2.2 LIST OF ADMINISTRATION PERSONNELS
SERIES
1
2
3
4
5
6
POSITION
General Manager
Operation Manager
Administration Manager
Marketing Manager
Financial Manager
Trained Workers
TOTAL
NO OF PERSONAL
1
1
1
1
1
2
7
17
2.3 SCHEDULE OF TASK AND RESPONSIBLITIES
POSITION
General Manager
Administration Manager
TASKS AND RESPONSIBILITIES
• Making connection and establishing contact
with the main supplier, PERTANIAN
PERTIWI SDN BHD.
• Form the business policies and guidelines
• Making decisions and solve all problems
faced by Fresh Chicken Farm.
• Help the Marketing Manager to promote the
chicken products.
• Find out more information and do research
about setting up and operating a chicken's
farm successfully.
• Choose quality livestock from the supplier,
PERTANIAN PERTIWI SDN BHD.
• Responsible and liable for all business risks or
any problems regarding business or workers
• To forecast sales and income
• To administrate the business structure
• Lay out all plans and ensure that all things are
done according to plans
• Determine the wages and salaries received by
workers and contribute the percentage of the
salaries to EPF and SOCSO.
• Make the decisions regarding administrative
tasks and office works.
• Responsible for all mails and correspondences
connected with the business.
• To assist general manager in the business
• To involve in guiding a new worker in case of
a new recruitment
• Help to achieve the business target by
implementing business ideas and strategies
18
Marketing Manager
Operations Manager
Financial Manager
• Find other strategies to help increase sales
• Analyze the strengths and weaknesses of
competitors.
• Handle the advertisement, banners and
signboard placement.
• Make sure the customer receive good service.
• Able to interact and try to make the customers
to have confidence in our business
• To analyze the opportunity in the economy,
choose and grab the opportunity based on the
business
• Find and place a suitable pricing for every
chicken product sold.
• Deal in the buying of food for the chicken
• Responsible for the training of new workers
and monitor the job quality of all operation
workers.
• Monitor th§ health of chickens.
• To make sure that all stocks are in good
condition
• To make sure all the stocks are enough to
meet the demand
• Informing suppliers when there are extra
orders needed
• Prepare the company financial report
• Keep all the financial records and business
accounts in the safety place.
• Record and monitor all the income received
and expenses incurred by the business.
• Responsible for controlling and managing
company's financial capital and cash flow.
19
• Advice the manager regarding the
matters.
• Make a budget of business example
financial
financial
statement, profit, and loss account, and
balance sheet
• Search for the information of capital
activities.
and asset
2.4 SCHEDULE OF REMUNERATION
DESIGNATION
General Manager
Operation Manager
Admin Manager
Marketing Manager
Financial Manager
Trained Workers
TOTAL
NO OF
EMPLOYEE
1
1
1
1
1
2
7
MONTHLY
SALARY
(RM)
1,700.00
1,300.00
1,300.00
1,300.00
1,300.00
1,000.00
7,900.00
EPF
(12%)
(RM)
204.00
156.00
156.00
156.00
156.00
120.00
948.00
socso(2.5%)
(RM)
43.00
33.00
33.00
33.00
33.00
25.00
200.00
TOTAL
(RM)
1,947.00
1,489.00
1,489.00
1,489.00
1,489.00
1145.00
9,048.00
20
2.5 LIST OF OFFICE EQUIPMENTS AND SUPPLIES
NO
1.
2.
TYPE
OFFICE EQUIPMENTS
a. COMPUTER (PARTNERS
CONTRIBUTION)
b. AIR CONDITIONER
c. TELEPHONE & FAX
MACHINE
d. FIRST AID
e. WHITE BOARD
f. CABINET/FILE FOLDERS
g. ADDITIONAL
ACCESSORIES
TOTAL
FURNITURES
a. CHAIRS
b. SOFA
c. TABLE
TOTAL
QUANTITY
1
1
1
1
1
4
8
1 SET
4
PRICE/UNIT
(RM)
1,180
1,000
100
120
400
60
1,100
150
TOTAL
(RM)
2,500
1,180
1,000
100
120
1,600
170
6,670
480
1,100
600
2,180
21
2.7 ADMINISTRATION BUDGET OF FRESH CHICKEN FARM
TYPE
Fixed Asset:
Land &Building
Furniture
Office equipments
Renovation
Monthly Expenses:
Salary, EPF, SOCSO
Stationary
Miscellaneous
Telephone bill
Other Expenses:
Registration & Licenses
Deposit
Insurance & Road Tax
Other Expenses
Fixed Asset
Cost
(RM)
138,000
2,180
6,670
-
-
-
-
-
-
-
Monthly Expenses
(RM)
-
-
-
-
6,414
50
100
500
100
-
-
Yearly Expenses
(RM)
-
-
-
-
76,968
600
1,200
6,000
1,200
-
-
22
23
3.0 INTRODUCTION
Marketing is a social and managerial process by which individuals and group
obtain what they need and wants through creating and exchanging products and value
with others. It can be defined as an activity that are carried out systematically to
encourage and increase sales of products or services as long as the activities are in the
line with religious and ethical practices.
Marketing is basically an exchange activity that takes place between a
business entity and its customers. The customers can conclude individuals, others
business entities (e.g. wholesalers and retailers) and support organizations (e.g. banks
and government agencies). Marketing is a critical activity in any business because it
forms the backbone to the total business effort in achieving a profitable outcome.
Consequently, the challenge in any business is to produce and offer a product that
results in profit for the business and, more importantly, satisfies the target customer.
r
3.1 PRODUCT OR SERVICE DESCRIPTION
Our business will be name as 'FRESH CHICKEN FARM'... holding one
marketing concept where our operation, strategy and manufacturing are done
regarding customer's needs and wants. In the other words, the customer satisfy is a
major concerning in every effort and strategy to ensure that our business can be
compete and more longer in market.
We have chosen a business that deal with the distributor, whereby they are an
agreement that the distributor will supplies the chick to us, then we will breed its until
a certain level before the chicken return back to them. There are only 18,000 chicks
per batch that we will take. It takes a year the contract of this business.
24
3.2 TARGET MARKET
The target market is defined as the groups of customers that have needs and
wants that can be satisfied by the business through the supply of goods and services.
It's important for us to have a target market to determine our customers needs and
wants towards chicken.
Since that our business has a contract with other company, which is our
distributor, therefore, our target market is 'Pertanian Pertiwi Sdn Bhd'(distributor).
Our company does not have a specific area or outlet to distribute our product because
we have a deal with the distributor. In the agreement, it states that we will get the
supplies (chicks) from the distributor and after a certain level, we will sell it back to
the distributor.
3.3 MARKET SIZE
Market size refers to the total potential purchase of the target market. Since we
have a contract, so the market size is depend on the purchasing of our distributor.
According to our distributor, we had been informed that their annual sale is
RM15,779,840. Therefore this is our market size. The table below shows the target
market of their company.
OUTLET
Wet Market
Hotel
Restaurant
Factory / School Canteen
Individuals
TOTAL
EXPECTED PURCHASE
Per year (RM)
5,52,944
3,155,968
4,733,952
1,577,984
788,992
15,779,840
PERCENTAGE
(%)
35
20
30
10
5
100
25
3.4 MAIN COMPETITORS
In our business operating, there are many competitors that operate a same
business like us. Competitors actually refer to other businesses that offer similar,
substitute or an alternative products or services to the same target market. We have to
analyze the strengths and weaknesses of our competitors in term of size, experience,
and years in business, financial ability and product line in order to compete together
with them.
Here we have identify some entrepreneurial that operate chicken business
located in the same area:
Hj. Kamaruddin b Hj. Ellyas
Kim Too Siong
En Baharen M.Daie.
All the above competitors have been long in this business before we entered
the business. Therefore, most probably they have established themselves and have
more experience in facing towards customers. What can we do is trying to have a
good business and make the competitors as our activator to succeed in the business.
26
STRENGTHS OF COMPETITORS
> They have been in the business for a long time before us and make them
already have permanent customer.
> They have a large source of capital to expand their market.
> They have more experience in operating the business compared to us.
Customers know them well and more confident to work with them.
WEAKNESSS OF COMPETITORS
^ Their operation management is not systematically.
^ The price of the chicken is not suitable with the quality of the product selling.
> Their farm is 'open system', produce low quality product.
> Less promotion to spread widely their business.
STRENGTHS OF FRESH CHICKEN FARM
^ Our operating is more systematic to ensure that our chickens are grower in
better condition.
> Our price is suitable with the size of chicken selling.
> We care of the quality of the chicken selling to buyer.
> Applied high technology on the farm. (Close system)
> We have well in promotion and ensure a good relationship with our
distributor.
* Nevertheless, we have our weakness that we are still new in our business and have
less experience compared to other competitor.
27
3.5 MARKET SHARE
Market share refers to the estimated potential sales of the business after taking
into consideration of the market size and competitors influences. Based on our market
size, RM 15,779,840 we can estimate our 5% share of market.
The table below shows the market share before and after 'FRESH CHICKEN
FARM' entered market.
Name of
Company
Hj. Kamrauddin b.
Hj. Ellyas
Kim Too Siong
En Baharen M.Daie
Others
'FRESH CHICKEN
FARM'
TOTAL
Before
%
share
25
20
15
40
100
Amount
(RM)
3,944,960
3,155,968
2,366,976
6,311,936
15,779,840
After
%
share
25
20
15
35
5
100
Amount
(RM)
3,944,960
3,155,968
2,366,976
5,522,944
788,992
15,779,840
28
3.6 SALES FORECAST
Sales forecast is expected purchases from the identified target market. There
will be an increase in our sales every year for our three years forecast seems that the
high demand for chicken in the market. There is a possibility that the customers needs
a better quality of chicken and choose us as their new supplier.
The following table shows the forecasted sell for the first three years.
Sales Forecast for year 2006,2007 and 2008 (RM)
MONTH
January - February
March - April
May - June
July - August
September - October
November - December
Total-2006
Total-2007
Total - 2008
NO OF
UNIT (kg)
41,055
41,055
41,055
41,055
41,170
41,170
246,500
246,500
246,500
SELLING PRIZE
(RM/kg)
3.20
3.20
3.20
3.20
3.20
3.20
3.20
3.20
3.30
AMOUNT
(RM)
131,376
131,376
131,376
131,376
131,744
131,744
788,992
788,992
813,450
In our business, we have a certain period of time to produce our product.
Operation of our product will take about two month before it's will be market.
Therefore, we just can make a forecast per batch, which means every two-month we
will gain in sales.
We start our project in January and get 18,000 of chick from the distributor.
From the table above, our product that we sell to the distributor is 41,055, which is
17,850 of chicken with average weight 2.3kg in the first, second, and third batch (Jan-
Aug). We expect that 150 chicken will died. On the forth and fifth batch, there are
only 100 died. To achieve this target, we will make sure that our operation was good.
The distributor also will help us by giving an extra 200 of chicks in every batch. On
29
September to December, they will give us extra 250 of chicks because of the festival
season.
From the graph below, it shows that our selling forecast in year 2006, 2007
and 2008. In the agreement, the price for a chicken is fixed, RM3.20/kg. The graph
shows that the pattern of selling in year 2006 and 2007 is same and in 2008, it will
increase 3% by increasing our selling price to RM3.3O/kg while we renew our
agreement with the distributor.
Graph On Sales Forecast
136,000
135,000
134,000
Amount 1 3 3 0 0 0
(kg) 132,000
131,000
130,000
129,000
— _ _
n rr r1
1 .,
i1
1 1 1
Month
n
-j
D Year 2006• Year 2007
„ • Year 2008
30
3.7 MARKETING STRATEGIES
Our business operating is supplying the meat chicken. In this business, we are
dealing with other company as a distributor which they as an agent to distributed our
product. We supply the chicken and they processed the chicken for selling to the
customer. Therefore, our marketing strategy is to make the distributor more confident
towards our quality of product. In order to achieve our target, we have developed
appropriate marketing strategies to generate the sales from the target market. There
are four factors to be considered which are as follows;
a) Product
b) Price
c) Place (distribution)
d) Promotion
a) Product
Our farm provides a good quality of chickens, which are from a good
heredity (grade A) and free from infectious disease. We will operate our farm
carefully to ensure that it's always been satisfy by our distributor. In this business, the
distributor will give a guideline for us to control our quality of products. To achieve
the standard level of our product, we will make sure that our operation will operate
according to the guideline given. Besides, the distributor will come to our farm every
two weeks to make sure that our chickens have a good health.
Our business provides a clean environment of a farm, which is very important
for giving a view to our quality product. A good quality of chicken also comes from
their good quality of feed.
b) Pricing
The price of chicken is fixed based on our agreement with the
distributor. Otherwise, in order to put a price for our product, we are using
'competition-based pricing' concept and make a comparison regarding quality and
31
size of the chicken. The proper price fixed by our business is RM3.20/kg where
usually the price fixed by competitors is RM3.50/kg.
c) Place/Distribution
We have chosen Jalan Kebun at Klang as our project site based on some
factor;
• Farm is far away from town and housing area
• Farm have access to transportation and be able to operate all the time
• Land are flat and have good drainage
• The area is well ventilated
Seems that our location is in Klang , its will encourage the distributor to make a deal
with us.
d) Promotion
An impressive promotion is needed to ensure that our missions are achieved.
A step of promotion should be taken in order to achieve our vision to make everyone
known our potential and get a chicken supply from our company.
Promotions are based on;
• Signboard
It's very important for each business to have a signboard to introduce the business
and let everyone know the location of the project site. Our business will have two
signboards that will be put in front of our office and the side of road that mention
the way to our farm.
• Business card
Our business card will be given especially to our vendors who visit our farm.
It's make people know how to contact us as a manager to make a business or
directly come to our farm based on address given.
32
Website
We will make a business website for our company seems that Internet is the
most important communication tool among the communities nowadays. All
information regarding our business will be advertised in the homepage
FreshGbkkenFarm
MOHAMMAD SHUKEYB. MAKSAH
(General Manager)
Lot 3307, Batu 7, LorongS&rkawi, Jalart Kebun,42450 Klang,Tel:03-31222372H/p : 019-3079070www. f reshchickenfa rm. com
FreshChicken F&rtn
MUHD NURFAIZB. BAHARUDDIN
(Marketing Manager)
Lot 3307, Batu 7, LorongSarkawi, Jalan Kebun,42450 Klang,Tel:03-31222372H/p : 012-6045320www. f reshchickenf a rm.com
Fresh€hickn Farm
MUHAMMAD FAIRUZ
B JOHARI
(Operation Manager)
Lot 3307, Batu 7, LorongSarkawi, Jalan Elebun,42450 Klang,Tel: 03-31222372H/p : 017-3082892www. f reshchickenf a rm. com
33
Fresh
AHMAD LUQMAN B.MOHAMMED SHAIHANI
(Financial Manager)
Lot 3307, Batu 7, LoiongSarkawi, Jalan Kebun,42450 Klang,Tel : 03-31222372H/p : 012-9157455www. f reshchickenfa rm. com
3.8 MARKETING BUDGET
Remuneration Table Monthly
POSITION
Marketing
Manager
MONTHLY
SALARY (RM)
1300
EPF
12%
(RM)
156
socso2.5%
(RM)
33
TOTAL
(RM)
1489
List Of Marketing Budget
Type
Fixed Asset
Signboard
Working Capital
Salary, EPF, SOCSO
Miscellaneous
Other Expenses
Business Card
Fixed Asset Cost
(RM)
500
Monthly Expenses
(RM)
200
Other Expenses
(RM)
100
34
35
4.0 INTRODUCTION
Operation Management
Operation management can be defined as the process of marshalling resources
to produce output through the transformation process. The operation process
comprises three main components, i.e. business input, transformation system and
output.
Business input refers to all resources required to produce a particular output.
Examples of input are manpower, raw materials, machines and equipment,
technology, information and capital. The transformation system refers to the activities
involved in transforming input into output. Among others, the processing system
involves planning of raw materials, designing of operational process, planning of
floor layout and distributing of manpower in the organization. Output refers to the end
product created as the result of the transformation process. Business output can be
categorized into either products or services. As input is transformed into output, it
acquires added value, whereby the value of the output is higher than the total input
value.
Our purpose focus in operational plan is to breed and to ensure chicken that
we supply is high quality to fulfill our customer needs and wants. With the quality,
exact time and place we planned at the lowest cost but give an optimum profit, which
will avoid misspend money.
It also to recognize and list down all the materials needed to effort by making
some arrangement for the quantity and quality of material needed and recognized
supplier.
36
4.1 FLOW CHART OF OPERATION ACTIVITIES
It is schematic representation of the operation process from the start until the end.
Ready of broiler closed house
Install the necessary brooding equipment
Received a day-old-chick (DOC)
Keep DOC in broiler close house
Check the chick quality
Daily control and quality control
Waiting for a growing process
Catching process
Distributor takes back the chicken
Disinfection process
37
FLOW CHART CONVENTIONAL SYMBOLS
SYMBOL
o
V
ACTIVITY
OPERATION
TRANSPORTATION
INSPECTION
DELAY
STORAGE
DESCRIPTION
Material are being
processed of planning and
calculating
Received and return the
chicken to the supplier and
delivered it to the customer
Inspection on the size,
weight, quality of the
chicken we ordered and
delivered
Waiting a growing process
Material and property are
stored in the storage
38
PROCESS FLOW CHART
1) Ready of broiler closed house
2) Install the necessary brooding equipment
3) Received a day-old-chick (DOC)
4) Keep DOC in broiler close house
5) Check the chick quality
6) Daily control and quality control
7) Waiting for a growing process
8) Catching process
9) Distributor takes back the chicken
10) Disinfection process
39
4.2 OPERATIONS SYSTEM
1) Ready of broiler closed house.
Our breeding project of day-old-chick required our company to build pens on
2.273 acres. Before we have building and planning construction of a boiler house,
firstly we select a site that is on well-drained land and has plenty of natural air
movement. The house should be oriented on an east-west axis to reduce the amount of
direct sunlight on the sidewalls during the hottest part of the day. The house is single-
storey and has a wide of 350 feet x 40 feet x 7 feet. The design is such that chickens
are not exposed to injury. This is close house system, so there is an alarm signal.
These alarm signals are useful to give a warning during a blackout. Then the
generator will be used to provide a power electric.
40
2) Install the necessary brooding equipment
a) Drinker System
This system providing clean, cool water with adequate flow rate is
fundamental to good poultry production. Without adequate water intake, feed
consumption will decline and bird performance will be compromised. Our company
has used closed systems {nipple systems).The nipple drinkers operate at a flow rate of
50 to 60 ml/min. The pressure is adjusted to maintain water flow to meet the broiler's
water needs and to adjust it, we use regulator. Nipple drinkers will be adjusted to suit
chick height and water pressure. It must have evenly distributed pressure optimized
for output without contributing to excessive dripping.
41
b) Feeding System
Our company has used auto pan feeding system. This system is allowing for
unrestricted bird movement throughtout the house, has a lower incidence of feed
spillage, and improved feed conversion. In addition, pan feeders fill simultaneously
minimizing bird competition when the feed lines are charged. Automated chain
feeders allow for a minimum of 2.5 cm (lin) feeder space per bird. The maintenance
of feed track, corners, and chain tension is essential. If the height is not adjusted
properly, it can restrict bird movement within the house. The feed depth is controlled
by feed slides in the hoppers and will be closely monitored to prevent feed wastage.
L-
42
c) Pad Cooling System
We have to monitor level of ammonia, carbon monoxide, carbon dioxide,
hydrogen sulfide and oxygen. In closed house system from time to time to ensure it
does not affect health of chickens and workers. When the thermostats or probes
detects the temperature below 30°C the water will be automatically flow out from the
front of the pens. The machine is calling the pad cooling system. Then the exhaust fan
will pull out any gases and air that are not at the good level. The suitable temperature
is according to stage of growth.
43
3) Chick Placement
We buy a chick from our head company, Pertanian Pertiwi. This day-old-chick
will be sending to us more than 18000 of chicks. These chicks are from same flock or
same age. The delay in placement can contribute to the dehydration of chicks,
resulting in higher chick mortality and reduced growth rate. Chick must be carefully
placed and evenly distributed near feed and water throughout the brooding area. The
light will be brought to full intensity within the brooding area once all chicks have
been placed. We have to monitor the distribution of the chicks closely during the first
few days. This can be used as an indicator for any problems in feeder, drinker,
ventilation or heating systems.
4) Chick Quality
Two hours after chick placement, we will be checking their quality. This is to
ensure they are comfortable with the temperature. Chicks too warm will try to move
away from heat, will be panting, will appear quiet and their wings may drop. Chicks
too cold will crowds towards the heat, will huddle in groups and be noisy. While,
chicks at the correct temperature will be evenly spread, show varied behavior (eating,
drinking, resting and interacting) and will be softly chirping. Characteristics of a good
quality chick are well dried, long fluffed down, bright round active eyes, look active
and alert, have completely healed navels, free of red hocks and should be free from
deformities.
44
5) Daily Control and Quality Control
a) Ventilation
In order to the proper temperature, ventilation needs to be considered.
Ventilation distributes heat throughout the house and maintains good air quality in the
brooding area. We have to monitor level of ammonia, carbon monoxide, carbon
dioxide, hydrogen sulfide and oxygen. In closed house system from time to time to
ensure it does not affect health of chickens and workers. When the temperature
transducer detects the temperature below 30°C the water will be automatically flow
out from the front of the house. The machine is calling the cooling pad system. Then
the exhaust fan will pull out any gases and air that are not at the good level. The
suitable temperature is according to stage of growth
Description
Temperature
Air speed
Thermostat
Weekl
33°C
<50 ft/min
34°C
Week 2
32°C
100 ft/min
32°C
Week3
29°C
200 ft/min
30°C
Week4
29°C
300 ft/min
30°C
Week5
29°C
400-500 ft/min
30°C
Exhaust Fan
45
b) Feed and Water
Our broiler management is always making sure that both the feeders and
drinkers are in adequate supply relative to the stocking density and are approximately
placed. The nipple drinkers would be at chicks' eye level for the first 2 to 3 days of
age and then maintained slightly above chicks' head. Pressure would be such that
there is a droplet of water suspended from the nipple but no leakage. The birds' feet
are always being flat on the litter and a bird will never have to stand on its toes to
drink. Feed are provides in crumb form and placed on trays. Feeders will be raised
incrementally throughout the growing period so that the pan is level with the bird's
hack at all times. The feed level within the feeders will be set so that feed is readily
ivailable while spillage is minimized.
46
c) Light
Light intensity will be minimum of 20 lux (2 foot candles) in the darkness
place in the brooding area during the brooding phase. Light intensity, distribution,
color and duration affect the performance and welfare of the flock. Proper light
placement and distribution will encourage chicks to find feed, water and warmth
during the brooding phase.
d) Disease Control
The veterinary will come every week to monitor disease status in house on a
schedule basis. The culled chicken will be separate before its spread. The antibiotic or
vaccine will be put in water. The use of the correct medication and the timing of
treatment can be crucial in combating a disease problem. The preferred choice of a
drug or antibiotic for some disease may be harmful if used for the treatment of others.
e) Bio-security
Bio-security is the term used to describe an overall strategy or succession of
measures employed to exclude infectious diseases from a production site. Outlined
below are the key points that make us successful in bio-security program.
> Keep door and gate lock at all times.
> Farms are fenced.
> No pet animal that are allowed in or around poultry housing.
> Limit non-essential visitors to the farm.
> If equipment must come from another farm, it would be thoroughly
cleaned and disinfected before it comes onto the farm.
> Farms have a toilet and hand washing facilities separate from the
poultry house.
47
6) Growing Phase
a) Uniformity
Uniformity is measure of the variability of bird size in a flock. The coefficient
of variation (CV) is commonly used to describe variability within a population. A low
CV indicates a uniform flock whereas a high CV indicates an uneven flock.
Coefficient of Variation
CV% = standard deviation
To estimate the CV of a flock, we will divide the house into three sections. A
random sample of approximately 100 birds from each section, or 1% of the total
population will be weighed and the individual weights recorded. It is important to
weigh all birds within the catch pen excluding culls. Birds will be weighed daily for
the first two weeks of age and weekly thereafter.
Flock Uniformity
CV
8
10
12
Uniformity
80%
70%
60%
Evaluation
Uniform
Average
Poor uniformity
b) Modification of Feed and Nutrient Intake
Adjusting dietary nutrient density or the physical form of the feed (mash vs.
pellet) will influence broiler growth rates. Lower nutrient density diets may have a
negative impact on feed conversion and yield but will cost less to produce. An
analysis of dietary cost versus bird performance is essential in determining the best
option.
48
c) Lighting Programs
Lighting programs are a key factor in proper broiler management and are
fundamental to optimal performance. Lighting programs are typically designed with
changes occurring at predetermined ages and tend to vary according to the final target
market weight of the broilers.
Description
Light
Weekl
23 hours
| | 0600
Week 2
20 hours
gj 0300 till
morning
Week 3
18 hours
g} 0100 till
morning
Week 4
Natural
Week5
sun light
7) Catching Process
Feed withdrawal will take place 8 to 12 hours before processing to reduce
carcass contamination. The purpose of feed withdrawal is to empty the digestive tract,
preventing ingesta and /or fecal material from contaminating the carcasses during the
evisceration process. When birds are fasted between 8 and 12 hours, the intestine is
almost completely empty yet strong enough to withstand the evisceration process
without rupturing.
Preparation for catching
> Water must be available until the start of catching
^ Lighting will be dimmed at the time of catching. If dimming is not
feasible, the use of blue or green bulbs will clam birds and reduce
activity.
> Remove or raise all equipment that may interfere with the catch crew.
> Careful management of the ventilation system is needed during
catching to ensure adequate house ventilation.
49
Dark strip curtains hung over the doors block out light during daytime
catching. These allow birds to remain quiet and will facilitate better ventilation.
Lightweight curtains can be used to partition the house into smaller pens. This can
reduce bird stress and diminish the risk of piling. Birds will be carefully placed in
clean crates or modules.
8) Disinfection
House will be disinfected thoroughly after every production cycle and left
empty for a suitable period of time (can stop breeding cycle of disease carrier) before
a new flock is brought in. Normally about 2 week. All farm equipment disinfected
thoroughly after use and kept in a clean and dry place.
43 BUSINESS OPERATION TIME
Our business operation starts from 9.30 am - 5.30 pm. We picked this time as
it is the appropriate time for any company / business to start and close their business
daily. In the daytime, chicken will be cared and well kept by our experienced workers
to make sure the safety and health of the birds. At night, they are allowed to roam and
wander in the farm but adequate food and water are still provided. They are the most
convenient animal to breed.
Operation time:
Monday - Friday : 9.30 am - 5.30 pm
Saturday - Sunday : 10.30 am - 4.30 pm
Our operations include the process of feeding, health care and breeding.
50
4.4 CAPACITY PLANNING
Below are the lists for cost of raw material per chicken:
Raw Material
i. Day Old Chicks
Starter Feed
Pre-Grower Feed
Grower Feed
Finisher Feed
Vaccine and Medication
11.
iii.
iv.
v.
vi.
Total
Cost per chicken (RM)
1.05
0.60
1.38
1.32
1.25
0.20
5.80
Average weight of a big chicken is 2.3 kg,
Total of raw material per chicken's weight = RM 5.80 / 2.3 kg
= RM 2.52
MONTH
January-February
March-April
May-Jun
July-August
September-October
November-December
TOTAL YEAR 1
TOTAL YEAR 2
TOTAL YEAR 3
NO OF UNIT
(kg)
41,400
41,400
41,400
41,400
41,400
41,400
248,400
248,400
250,500
COST OF RAW
MATERIAL PER
CHICKEN
(RM/kg)
2.52
2.52
2.52
2.52
2.52
2.52
2.52
2.52
2.52
AMOUNT (RM)
104,328
104,328
104,328
104,328
104,328
104,328
625,968
625,968
631,260
51
4.5 TOTAL COST
MONTH
January-February
March-April
May-Jun
July-August
September-October
November-December
TOTAL
AMOUNT
104,328
104,328
104,328
104,328
104,328
104,328
625,968
4.6 MATERIAL REQUIREMENTS (INPUT)
The following are the input of the operation process.
Raw
i.
ii.
iii.
iv.
V.
vi.
Total
Material
Day Old Chicks
Starter Feed
Pre-Grower Feed
Grower Feed
Finisher Feed
Vaccine and Medication
I
Cost per chicken (RM)
1.05
0.60
1.38
1.32
1.25
0.20
5.80
52
4.7 LIST OF OPERATIONS PERSONNEL
POSITOIN
Operation Manager
Farm Workers
NO. OF PERSONNEL
1
2
4.8 SCHEDULE OF TASKS AND RESPONSIBILITIES
POSITION
Farm Workers
RESPONSIBILITY/DUTY
>• Gives a good co-operation as to
maintain the smoothness of the
operation
> To make sure the entire auto pan
feeding system, nipple drinking
system, brooding system and
control system are in good
condition.
> To make an immediate report on
machine, equipment or other
damages.
> Gives a food or other daily routine
at the applicable time.
> Always obey the rules that fixed
by company.
53
4.9 SCHEDULE OF REMUNERATION
POSITION
Operation
Manager
Farm
Worker
TOTAL
NO.
1
1
3
MONTHLY
SALARY
(RM)
1,300
500(each)
2^00
EPF 12%
(RM)
156
120
276
socso2.5%
(RM)
33
25
58
TOTAL
1,489
1,145
2,634
54
4.10 MACHINE AND EQUIPMENT
a) Infrastructure Development Cost (RM)
i. Construction of access road
ii. Land clearing
iii. Fencing
iv. Main Drain System
TOTAL
6,000
10,000
15,000
8,000
39,000
b) Equipment and Machinery
ITEM
1
1.1
1.2
1.3
1.4
1.5
1.6
TYPES
PAD COOLING SYSTEM
50" fan 1.0 hp 380 V with auto shutter
Cooling Pad 6"x 24"x 60"
5'xl0' S.S Frame for Cooling Pad
Water tank with capacity of 150 gallon
Install connection of water pipe
Water pump 1.0 hp
Total for item no. 1
2 BOTH SIDE CURTAIN
Total for item no.2
NO.
8
80
8
2
1
2
TOTALCOST
(RM)
28,000
6,200
55
3
3.1
3.2
3.3
3.4
3.5
3.6
AUTO PAN FEEDING SYSTEM
Feed Hopper
336' steel pipe complete with plastic pan and
0.5 hp motor
Hand winch
Height adjusted of the auto pan feeding
system-336'
1 Gallon Drinker for day-old-chick
Square chick tray for day-old-chick
Total for item no.3
4
4.1
4.2
4.3
4.4
NIPPLE DRINKING SYSTEM
Regulator
Nipple water PVC pipe and aluminum bar
340' long.
Hand winch
Height adjusted of the nipple drinking
system-336'
Total for item no. 4
5
5.1
BROODING SYSTEM
Brooder gas
Total for item no. 5
6
6.1
6.2
6.3
CONTROL SYSTEM
Control system for 50" exhaust fan
Control system for water pump
Control system for Pan Feeding
Total for item no. 6
7
7.1
7.2
7.3
ELECTRICAL SUPPLY
Sub-board
Lamp
Lamp post
3
3
3
3
200
200
4
4
4
4
15
1
1
1
1
50
2
23,000
14,600
4,200
8,000
56
7.4 Electrical wiring for lamp, fan and water
pump in broiler closed house.
Total item for no.7
8
8.1
GENERATOR
1 unit Gen-Set
Total for item no. 8
9
9.1
WATER SUPPLY
1 unit water tank
Total for item no.9
10
10.1
10.2
Others
Trolley
Safety gear and tooling
TOTAL FOR ALL ITEM
1
1
2
12,000
10,000
5,000
200
2,000
113,200
Therefore the total costs are;
Cost of Infrastructure Development + Cost of Equipment and Machinery
= RM 39,000 + RM 113,200
= RM 152,200
57
4.11 OPERATIONS SPACE LAYOUT PLAN (BROILER CLOSED HOUSE)
a
oo
KEYS
Feed Hopper
[] 0.5 HP Motor
• Regulator
50" Exhaust Fan
Water tank
Storage and Control Room
Auto Pan Feeding Lines
Nipple Line
Plastic pan
Cooling Pad
58
4.12 OPERATION OVERHEAD
Below are the lists of estimated broiler production cost for overhead expenses:
Types Cost per chicken (RM)
i. Electricity 0.20
ii. Water 0.08
iii. Wood Shaving 0.08
iv. Catching Crew 0.15
v. Gas for brooding 0.08
Total 0.59
Total costs for operation overhead are:
= RM 0.59 X 18,000 chickens + Maintenance of Machinery + Miscellaneous
= RM 10,620+RM 250 +RM 200
= RM 11,070
NO.
1
2
3
4
5
ITEM
UTILITY
1.1 Water
1.2 Electricity
MAINTENANCE OF MACHINERY
TOOLS AND DYES
3.1 Wood shaving
3.2 Gas for Brooding
PARTIME WORKER (3 catching crew)
MISSELLANEOUS
TOTAL
AMOUNT PER MONTH
(RM)
5,040
250
2,880
2,700
200
11,070
59
4.13 OPERATION BUDGET
PARTICULARS
Fixed Asset
> Equipment and
Machinery
> Infrastructure
Development
Working Capital
> Purchase of
Material
> Salaries,
EPFand
SOCSO
> Operation
Overhead
Other Requirements
> Deposit
> Other
Expenses
TOTAL
FIXED
ASSET
COST
(RM)
113,200
39,000
152,200
MONTHLY
EXPENSES
(RM)
104,328
1,145
11,070
116,543
OTHER
EXPENSES
(RM)
5,000
2,500
7,500
TOTAL
113,200
39,000
104,328
1,145
11,070
5,000
2,500
276,243
60
H
5
61
5.0 INTRODUCTION
The most crucial before starting a new business is how to get the capital and
how the capital will be use. Financial system is basic thing or features in a business
and it is the main source to control the journey of a business.
A complete set of account which is related with the organization journey will be
prepared by the chosen Financial Manager; to financial statement every year. It will
show the profit or loss of our company, assets, liabilities and the stability and growth
of our company's financial to make it faster. Besides, financial system can give us
clear picture about return of capital that will be gain or capital investment that has
been done.
The information of financial plan is gathered on the input from the
"ministrative budget, marketing budget and operation budget.
In the financial, we have prepared the working paper, schedule and financial
itement. The statements are:
> Project cost schedule of the project
> Sources of financial
> Schedule of loan repayment
> Schedule of hire purchase
> Schedule of fixed assets depreciation
> Cash flow pro-forma
> Profit and loss pro-forma
> Balance sheet pro-forma
62
OBJECTIVE
The objective of financial plan is;
> To determine the amount of money to be invested that is the project cost.
> To identified and propose the relevant source fund
> To ensure that the initial capital is sufficient
> As a guideline for implementation
> To know whether the business is competitive or not
^ To determine the potential of the business to generate profit
> Cash outflows and cash inflows in the business project
> Hire purchase installment payment
> Loan installment payment
> Depreciation on the fixed assets
> The company's capital structure
> The total cost that we need to start the business
> Cost or paid up capital involves for starting the business
63
5.1 PROJECT IMPLEMENTATION COST SCHEDULE
RM
Capital Expenditures/Investment in Fixed Asset
Land & Building 13 8,000Furniture 2,180Office and Equipments 6,670Infrastructure Development 39,000Sign Board 500Machinery 113.200Total 299,550
Working Capital/Monthly Expenses (for 2 month)
AdministrativeMarketingOperationDay-old-chick (DOC)Total
Other Expenses
DepositCompany Registration & license FeesOther Expenses for operationBusiness Card
TotalContingencies (2%)
14,128400
24,43018.900
5,000100
2,500100
57,858
7,7007,302
TOTAL 372,410
64
5.2 SOURCE OF FINANCE SCHEDULE
Equity Contributions RM RM
Partners Contribution:
Mohamad Shukry bin Maksah
Muhammad Fairuz bin Johari
Muhd Nurfaiz bin Baharuddin
Ahmad Luqman bin Mahammed Shaihani
Sub-Total
External Sources
Bank Loan
Existing asset
Sub-Total
34,910.00
15,000.00
15,000.00
15,000.00
79,910.00
290,000.00
2,500.00
292,500.00
TOTAL SOURCES OF FINANCE 372,410.00
65
5 3 SUPPORTING SCHEDULES
LOAN OF AMORTIZATION SCHEDULE
Total Loans: RM 290,000.00
Interest rate: 4 %
Duration : 4 years / 48 months
Method : Flat Rate Method
YEAR
1
2
3
4
5
6
7
PRINCIPAL
72,500
72,500
72,500
72,500
0
0
0
INTEREST
11,600
11,600
11,600
11,600
0
0
0
TOTALREPAYMENT
84,100
84,100
84,100
84,100
0
0
0
BALANCE
217,500
145,000
72,500
-
-
-
66
FIXED ASSET DEPRECIATION SCHEDULE
Type of Asset : Furniture
Actual Price : RM 2,180.00
Economic Life: 5 years
Method : Straight Line Method
Year
1
2
3
4
5
Yearly Depreciation
436
436
436
436
436
Total Depreciation(RM)
436
872
1,308
1,744
2,180
Balance(RM)
RM 1,744.00
RM 1,308.00
RM 872.00
RM 436.00
67
Type of Asset : Equipment
Actual Price : RM 6,670.00
Economic Life: 5 years
Method : Straight Line Method
Year
1
2
3
4
5
Yearly Depreciation
RM 1,334.00
RM 1,334.00
RM 1,334.00
RM 1,334.00
RM 1,334.00
Total Depreciation(RM)
1,334.00
2,668.00
4,002.00
5,336.00
6,670.00
Balance(RM)
5,336.00
4,002.00
2,668.00
1,334.00
-
68
Type of Asset : Signboard
Actual Price : RM 500.00
Economic Life: 5 years
Method : Straight Line Method
Year
1
2
3
4
5
Yearly Depreciation
RM 100.00
RM 100.00
RM 100.00
RM 100.00
RM 100.00
Total Depreciation(RM)
RM 100.00
RM 200.00
RM 300.00
RM 400.00
RM 500.00
Balance(RM)
RM 400.00
RM 300.00
RM 200.00
RM100 .00
-
69
Type of Asset : Machinery
Actual Price : RM 113,200
Economic Life: 5 years
Method : Straight Line Method
Year
1
2
3
4
5
Yearly Depreciation
RM 22,640.00
RM 22,640.00
RM 22,640.00
RM 22,640.00
RM 22,640.00
Total Depreciation<RM)
RM 22,640.00
RM 45,280.00
RM67,920.00
RM90,560.00
RM113,200.00
Balance(RM)
RM 90,560.00
RM 67,920.00
RM 45280.00
RM 22,640.00
70
Type of Asset : Infrastructure Development
Actual Price : RM 39,000
Economic Life: 5 years
Method : Straight Line Method
Year
1
2
3
4
5
Yearly Depreciatioii
RM 7,800.00
RM 7,800.00
RM 7,800.00
RM 7,800.00
RM 7,800.00
Total Depreciatioii(RM)
RM 7,800.00
RM 15,600.00
RM23,400.00
RMS 1,200.00
RM39,000.00
Balance(RM)
RM 31,200.00
RM 23,400.00
RM 15,600.00
RM 7,800.00
-
71
5.4 PROFORMA FINANCIAL STATEMENTS
CASH FLOW PROFORMA (ANUALLY)
Cash InflowsOwners' Capital(cash)Bank LoanSalesCollection ofAccounts Receivable
Total Cash Inflows
Cash OutflowsAdministrativeExpenditure:Salary, EPF, SOCSOStationaryMiscellaneousTelephone
MarketingExpenditure:Salary, EPF, SOCSOMiscellaneous
OperationalExpenditure:Cash PurchasesSalaries, EPF,SOCSOOperation Overhead
DepositRegistration &LicensesOther ExpensesPurchase of FixedAssets - Land &BuildingPurchase of FixedAssets - Others
Yearl(2006)
79,910.00290,000.00394,496.00361,560.00
1,125,966
76,968.00600.00
1,200.006,000.00
-2,400.00
113,400.0013,740.00
132,480.00
5,000.00100.00
2,600.00138,000.00
159,050 .00
YEAR 2(2007)
--
394,496.00394,557.00
789,053.00
76,968.00600.00
1,200.006,000.00
-2,400.00
113,400.0013,740.00132,480.00
_-
2,600.00-
-
YEAR 3(2008)
--
406,725.00405,706.00
812,431.00
76,968.00600.00
1,200.006,000.00
-2,400.00
113,400.0013,740.00
495,960.00
_-
2,600.00-
-
72
Loan PaymentPrincipleInterest
Total Cash Outflows
EXCESS/(DEFICIT)
Opening CashBalance
Ending CashBalance
72,500.0011,600.00
735,998.00
389,968.00
389,968.00
72,500.0011,600.00
433,848 .00
355,205.00
389,968.00
745,173 .00
72,500.0011,600.00
776,668 .00
378,583.00
745,173.00
1,123,756.00
73
PROFORMA PROFIT AND LOSS ACCOUNTFRESH CHICKEN FARM
Proforma Profit and Loss Account for the Year Ending 31 Dec 2006RM
RMSales788,992Less: Cost of Goods Sold
Opening Stock Purchases 113,400Gross ProfitLess Expense:Administration Expenses:
Salary, EPF, SOCSO 76,968Stationary 600Miscellaneous 1,200Telephone 6,000
Marketing Expenses:Salary, EPF, SOCSOMiscellaneous 2,400
Operation Expenses:Salaries, EPF & SOCSO 13,740Operation Overhead 132,840
Financial Expenses:Interest on Loan 11,600Depreciation on Fixed Assets 32,310
Registration & Licenses 100Other Expenses 2,600
Total Expenses 393,758
Net Profit before Taxes 395,234Net Profit after Taxes 395,234Accumulated Net Profit 395,234
74
PROFORMA BALANCE SHEET ACCOUNTFRESH CHICKEN FARM
Proforma Balance Sheet for the Year Ending 31 Dec 2006
RM
Fixed AssetLand & BuildingFurnitureEquipmentsSignboardMachinery
Infrastructure DevelopmentTotal Fixed Asset
Current AssetDepositAccounts ReceivableCash
138,0001,7445,336
40090,56031.200
267,240
5,00032,936
389.968Total Current Asset 427,904
Total Asset 695,144
Owner EquityCapital (Owner's Equity)Accumulated Profit
Total Liabilities
82,410395.234
Total Equity
LiabilitiesLoans balance
477,644
217.500217,500
TOTAL EQUITY AND LIABILITIES 695,144
75
Fi
Oil
76
CONCLUSION
Based on the business plan that has been done, we have not only shown the financial
performance of this business but also the capability of the business. Because this kind
of business is rather new, our company is confident that we can penetrate the market
share.
From our observation, we also found that the Malaysian's stable economic situation
and the Malaysian's fondness to try new type of food especially Chinese will help to
encourage our business to grow. Adding to the fact that chicken's meat is lower in
cholesterol that any other meat found in the market, we are also confident that this
will also attract the health-conscious people to try this new alternative food.
The organization team for FRESH CHICKEN FARM consists of 4 dedicated,
disciplined and motivated individuals with the same aim of strengthening the
company.
As a conclusion, we strongly believe that FRESH CHICKEN FARM has a potential
in running this business and has the competitive edge to succeed.
77
I ,\ I)
78
The environment of location before the project being proceeds
4- The location under construction.
4- Our products.
Mohammad Shukry B. Maksah
No. 41, Jalan Sri Damak 50,
Taman Sri Andalas,
41200 Klang
Selngor
To Whom It May Concern.
Dear Sir,
Agreement on using land at Lorong Sarkawi, Jalan Kebun, Klang Selangor.
I am, Siti Bt Hj. Abdul Rahman as the owner of the land located above, agree to let
my niece to develop that unoccupied land to open a broiler house with some
incentives as in return. I will not be accused if they had a problem or involved in
problem.
Thank You,
Your Faithfully
SitiBtHj. Rahman
(No. VC: 4297581)
October 2, 2005
FRESH CHICKEN FARM
Lot 3307, Batu 7, Lorong Sarkawi,
Jalan Kebun,
42450, Klang
Selangor Darul Ehsan.
Dear FRESH CHICKEN FARM,
Contract Farming With FRESH CHICKEN FARM At Jalan Kebun, Klang,Selangor
We are please to inform you that we have accepted your proposal to rear 18,000 birds/ flocks about 1 houseon a piece of land specifies above with the concept of new broiler closed house.
You will have to construct the chicken's house according to Pertanian Pertiwi Sdn. Bhd. Specifications andwill sign a Contract Farming Agreement with Pertanian Pertiwi when the construction of the chicken houseis completed.
The company will then supply you day-old-chicks and feed according to the agreement that will be signedwhen you have complete construct your chicken house. We will market all the birds when they reach marketsize.
Thank you.
Yours faithfully,
Mr. Liau Chai Peng
Branch IManager(Klang)
Pertanian Pertiwi Sdn. Bhd.
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TP 69A
PERMOHONAN UNTUK PERKHIDMATAN PERNIAGAAN
(Telefon-Datel-Teleteks-Tetefax-Teleks)
Rujukan
NAMAPENUH I I 1 I I I I 1 I I ' 1
(Seperti dim K/Pengenalan/Paspot/Sljil Daftar Perniagaan)
Jika perkhidmatan adalah di bawah nama Peiniagaan/Kerajaan/Kedutaan,dll., nyatakan Nama Pengguna dan Pangkat.
Untuk KegunaanPejabat Sahaja
NAMAPENUHPENGGUNA
PANGKAT
Kod KategonPelanggan
1 I I I 1 I I I I
1 1 1 1 I 1 I J1 I I I I
No. Kad Pengenalan
No. PendaftaranPerniagaan
J I
No. Paspot
NegaraI I I I I 1 I
I I I IKod Negara
ALAMAT PERSURATAN : No.
No Lot/No. Pangsapuri :
Tingkat • I
Nama Jalan :
Tmn./Seksyen :
Peti Surat :
I I I 1
II I
Bangunan . I I_J LJ L
I I I I I I I I I I
L _ J I I I I I I I I I I 1 1 I l
Bandar :
No. I
I I I I I I
I I I I I I
Poskod :
Negen :
I I I I I
I J I
J I
Bangunan :
Nama Jalan :
Tmn./Seksyen ;
Poskod :
Bandar : L
ALAMAT PEMASANGAN (Jika berlainan daripada alamat persuratnn) '
J Tingkat I I I No. Lot/No. Pangsapuri : I I I I I I
I ! I I I I I I I I I J I I I I I I I I
I I I I I I J
I 1 _L_ J I L I I I I
1 I I
J |.J LJ Negeri : 1 I I I I
TANDAKAN ) DALAM KOTAK ' <i BERKENAAN Lihat Sebelah
PERKHIDMATAIM DIPERLUKAPJ
TALIAN IBUSAWATTERUS ATD (ISO) SAMBUNGAN SELARI RAOAS TELEFON TAMBAHAN
Bil TalianOikehendaki
PERKHIDMATAN
P A B X
KEYTELEFON
Jems/Model
BilSambungan
BilStesen
Bil NomborUtama
Bil. NorpborAuxiliary
PERKHIDMATAN TELEMATIC
PERKHIDMATAN
DATEL
TELETEKS
TELEFAX
Jems/ModelRadas
Jems/ModelModem
Catatan "
Menggunakan Nombor Telefon yang sediada J 1 I I" I I I
PERKHIDMATAN
TELEKS
Jems RadasCadangan Kod Jawab-Balik
[ I I
KEMUDAHAN TAMBAHAN/CIRI-CIRI KHAS DIKEHENDAKI .
CATATAN
Tahun Bulan Han
Tandatangan Pemohqn
TANDAKAN ( ̂ ) DALAM KOTAK YANG BERKENAAN
Jika menggunakan radas sendirf, sila kemukakan surat pembekal. Cuma radas Kelulusan STM/JTM (Kswasolia) boleh digunakan.
PNA. 42PEJA&AT PENDAFTAR PERNIAGAAN
Permohonan Kelulusan Nama Perniagaan(Tiada Bayaran Dikenakan)
Saya memohon menggunakan salah satu nama-nama perniagaan dibawah:
( a )
( b )
( c )
* Nama dan Alamat Pemiiik / Pekongsi * No. Kad Pengenalan & Wama((.junakan lampiran lamjika pemiiik lebih 3 orang)
(a)Nama: Baru: .
Alamat: Lama:
(b)Nama : Baru:
Alamat: Lama:
(c)Nama : Baru:
Alamat: Lama:
* Jenis perniagaan dijalankan :
# Tarikh * Tandatangan Pemohon :
Nama :
No. K/P :
# No. Rujukan:
# No. Rujukan:
# Catatan :
Tarikh:(
Penolong Pendaftar Perniagaan+ Sila lihat syarat kelulusan dimuka sebelah. Kuala Lumpur* Pemohon hendaklah melengkapkan ruangan-ruangan ini.# Ruangan ini dibiar kosong.
Syarat-syarat Kelulusan
1. Permohonan nama perniagaan yang tidak meraenuhi syarat di bawah akan ditolak:
a. Nama perniagaan tidak bersesuaian dengan jenis perniagaan yang dijalankan.b. Nama yang dipohon telah digunakan oleh peniaga lain.c. Menggunakan nama diri yang bukan nama sebenar pemilik.d. Menggunakan perkataan yang dikawal oleh Pendaftar.e. Nama yang tertakluk di bawah Kaedah Pendaftaran Perniagaan 1957.
2. Nama yang diluluskan tidak boleh dipinda/ditambah perkataan atau huruf.
3. Kelulusan ini tidak boleh dipindah milik kepada orang lain.
4. Permohonan baru perlu dibuat jika perniagaan tidak didaftarkan selepas tamat tempoh kelulusannama perniagaan.
5. Permohonan yang mempunyai perniagaan lain yang telah tamat tempoh laku Sijil PerakuanPendaftarannya hendaklah memperbaharui Sijil Perakuan itu dahulu atau memfailkan Borang ' C .
6. Pemilik/Pekongsi mestilah bermastautin di negeri di mana perniagaan dijalankan.
KELULUSAN INI MENJADI BATAL JIKA SATU ATAU SEMUA SYARAT DI ATAS TIDAKDIPATUHI.
KAEDAH-KAEDAH PENDAFTARANPERNIAGAAN 1957
(KAEDAH 3)
PENDAFTARAN PERNIAGAAN
UNTUK KEGUNAAN PEJABATNO.PERAKUAN
DIBIARKAN KOSONG
BORANGA
f>ENDAFTARAN PERNIAGAAN,
Saya/Kami yang bertanggungjawab menyerahkan butir-butir berikut mengenai perniagaan yang tersebut di bawah miuntuk didaftarkan.
Saya/Kami menyerahkan Wang Kiriman/Wang Tunai sebanyak RM25/RM50 untuk bayaran pendaftaran dan untuk^erakuan Pendaftaran.
A. MAKLUMAT PERNIAGAAN
1. NAMA PERNIAGAAN
2. TARIKH MULA BERNIAGA 3. PERJANJIAN PERKONGSIAN (PILIH SATU)
ADA (LAMPIRKAN SURAT PERJANJIAN)
TARIKH
TIADA
4. ALAMAT TEMPAT UTAMA/PENGKALAN PERNIAGAAN
4.1. BANDAR 4.2. POSKOD 4.3. NEGERI (KOD)
.5. ALAMAT SURAT-MENYURAT (JIKA BERLAINAN DARI DI ATAS)
15.1. BANDAR 5.2. POSKOD 5.3. NEGERI (KOD)
KAEDAH-KAEDAH PENDAFTARANPERNIAGAAN 1957
(KAEDAH 3)
PENDAFTARAN PERNIAGAAN
B. MAKLUMAT'CAWANGAN
UNTUK KEGUNAAN PEJABATNO PERAKUAN
DIBIARKAN KOSONG
BORANGA
ALAMAT CAWANGAN
1. BANDAR 1.2. POSKOD 1.3. NEGERI(KOD)
ALAMAT CAWANGAN
.1 . BANDAR 1.2. POSKOD 1.3. NEGERI(KOD)
ALAMAT CAWANGAN
.1. BANDAR 1.2. POSKOD
•
1.3. NEGERI(KOD)
2
KAEDAH-KAEDAH PENDAFTARANPERNIAGAAN 1957
(KAEDAH 3)
PENDAFTARAN PERNIAGAAN
C. IVIAKLUMAT PEMILIK
UNTUK KEGUNAAN PEJABATNO. PERAKUAN
DIBIARKAN KOSONG
Nota: Tiap-tiap pemilik hendaklah mengisibutir-butir bahagian ini dalamhelaian berasingan.
BORANGA
1. NAMA PEMILIK 2. JANTINA
LELAKI
PEREMPUAN
3. NO. PENGENALAN DIRI
KAD PENGENALAN(BARU)
PASPORT POLIS TENTERA
KAD PENGENALAN (LAMA)
4. WARNA
BIRU MERAH LAIN-LAIN
5. TARIKH LAHIR
6. ALAMAT KEDIAMAN
6.1. BANDAR
7. BANGSA
MELAYU
CINA
INDIA
BUMIPUTERA SABAH
BUMIPUTERA SARAWAK
LAIN-LAIN(SILA NYATAKAN)
6.2. POSKOD
6. KERAKYATAN
MALAYSIA
PENDUDUK TETAP(NYATAKAN NEGARA ASAL)
10. TANDATANGAN PEMILIK
6.3. NEGERI (KOD)
9. PEMILIKAN
KETUANPUNYAANTUNGGAL
KONGSI UTAMA
KONGSI BIASA
KAEDAH-KAEDAH PENDAFTARANPERNIAGAAN 1957
(KAEDAH 3)
PENDAFTARAN PERNIAGAAN
UNTUK KEGUNAAN PEJABATNO. PERAKUAN
DIBIARKAN KOSONG
t). MAKLUMAT JENIS PERNIAGAAN
UNTUK KEGUNAAN PEJABATKOD JENIS PERNIAQAAN
DIBIARKAN KOSONG
BORANGA
I. JENIS PERNIAGAAN
2. TARIKH
KAEDAH-KAEDAH PENDAFTARANPERNIAGAAN 1957
(KAEDAH 3)
PENDAFTARAN PERNIAGAAN
E. PENGESAHAN OLEH SEKUTU-NIAGA
UNTUK KEGUNAAN PEJABATNO. PERAKUAN
DIBIARKAN KOSONG
BORANGA
Saya/Kami yang bertandatangan di bawah ini mengesahkan bahawa segala kenyataan yang dibuat dalam borang ini
adalah tepat dan mengaku bahawa saya/kami adalah sekutu dalam perniagaan bernama
NAMA PENUH NO. KAD PENGENALAN/WARNA TANDATANGAN/CAP IBU JARI KANAN
Saya mengaku bahawa tandatangan/cap ibu jari kanan di atas telah diturunkan pada akuan di atas ini di hadapansaya setelah saya berpuashati bahawa orang yang menurunkan tandatangan/cap ibu jari kanan itu adalah sebenarnyaDrang yang namanya tersebut dalam akuan itu dan ia/mereka faham maksud akuan itu.
Bertarikh di. .pada. .haribulan . tahun.
NAMA :
JAWATAN :
ALAMAT :(TANOATANGAN DAN COP RASMI
PEGAWAI PENGESAH)
Catatan: Pengesahan di atas hendaklah disaksikan oleh - Ahli Parlimen atau Ahli Dewan UndanganNegeri, Hakim, Majistret, Pegawai Kumpulan Pengurusan dan Profesional, Peguambela atauPeguamcara, Penghulu, Penggawa, Jaksa Pendamai (J.P), atau Pesuruhjaya Sumpah.
AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991BORANG PENDAFTARAN AH LI
KWSP 3 (AHL)
10. MAJIKAN.NO. AHL1:
KEGUNAAN KWSP
fama Ponuii I'ekcrja:
NO. Kad Pengehalan: Jantina:
o. K/P Lamu/Paspot: Tarikh Lahir: _—
A'arganegara: Keiurunan •
UNTUK KEGUNAAN KWSP j
I KWSP 3 [ J
I Mama Ringkas
j T'/tangan Pengesah:
j Jaw at an:
I'arikh:
KWSP 4
ku dan m o n i v s a h k a n b a h a w a bu{'::- S:i\a m c n e a k u bahawa bul i r -bul i r
.-:\':;;ai J; aia^ -idaiah beiul dan ')cn;:r vanu tcrcai!il di alas adalah bctul |
u! iVm..'. liul..:' boi iau dan kcdua C'-.i|i d a n b e n a i m c n g i k u t K a J
CAP IBU JARI AJHLI
K1RI
i b i i .!.;! in'>; i • - i i i n d i ; i i r ' i n k ; i ' ! d i h a d a p a n say a.
Tandatangan: .(Majikan. Wakil Majikan atau Pegawai KWSP)
Jawatan:
No. K/Pengenalan:
Tarikh:
reii;:en<iian S
Tandatangan:(Pekerja)
Tarikh:
i ' i K M • • • < - • v ' i . - v ' - - : A •••d'P i \ K A N i-:.AI") i ' l • N ( , I ' . N ; \ L A \ .
KANAN
L1HAT DI BFLAKANG
MA A1ILI':
LA.MAT All LI:
.i A NIC i A N Dl i ' L K A I K A N
TUAN/PUAN
yNDAITARAN KWSP 3
lAdalah dimaklumkan pecniohonan Tuan/Puan untuk menjadi ahli KWSP telah diterima dan kad keahlian akan dihantar
epada Tuan/Puan sebaik sahaja urusan pendaftaran telah dise inpuniakan.
ckian.
f.p l'engernsi HksekutifLembaga Kunipulan Wang Simpanan Pekerja.
tarikh:
ALAMAT TUAN/PUAN
NO. TELEFON
ALAMAT WARIS
TERDEKAT:
POSKOD
BANDAR
NEGERI
NO. TELEFON
POSKOD
BANDAR
NEGERI
PERHATIAN:
SEKIRANYA TUAN/PUAN TELAH BERPINDAH ALAMAT, SILA ISIKAN BORANG KWSP 1866 DAN HANTARKE PEJABAT KWSP YANG BERHAMPIRAN DENGAN TEMPAT TINGGAL TUAN/PUAN.
Sava
AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991BORANG PENAMAAN
No. K./P
KWSP4(A>!L)
dan No. Ahli
(NAMA AHLI)
menamakan mdividu seperti disebutkan di bawah un'uk menerima simpanan KWSP apabila berlaku kcniatiankeatas diri sava.
NAM A NO. K.P/SURAT BERANAK PERTALIAN BAHAG1AN
JANGAN DICERAIKAN
SILA LIHAT DI BELAKANG
NAMA AHLI:
ALAVIA'I AHLI:
TUAN/PUAN
PENAMAAN KWSP 4
Adalah dimaklumkan penamaan Tuan/Puan bertarikh
l.Telah didaftarkan
2.Tidak dapat didaftarkan kerana belum mencapai 18 tahun/borang tidak lengkap.
Sekian.
b.p Pcnge.-usi EksekutifLenibaga Kumpulan Wang Simpanan Pekcrja.
Tarikh:
Penamaan ini bertarikh Hniibulan 20 membaf.ilkan penainaan yang tcrdahulu
AKUAN SAKSI
Saya dengan ini mengcsahkan kenyataan di alas telah dibuatoleh ahli dan cap ibu jarinya telah diturunkan di hadapan sava.
Nama penuh saksi:
No k p saksi
Pekerjaan:
Alamat saksi:
CAP IBU JAR! AHLI
Tandatangan saksi.
Tarikh,
UNTUKKBGUNAANKWSPSAIIAJA
TARIKH TERIMA 'IARIKH DIDAFTAR
KIRI KANAN
PERHATIAN:
i) S e k i r a n y a c a p ibu j a r i k i r i / k a n a n r o s a k. si I a
tandaiangani pada scbelahan cap ibu jari lersebut
li) Jika seorang ahli Kumpulan Wang yang beragama
Is l am mat i d e n g a n m e m b u a t p e n a m a a n m e n g i k u t
Pe ra tu ran -pe ra tunn mi , orang atau bebeiapa orang yang
d inamakan itu hendak lah m e n e r i m a kicdi t ahl i \ a n g
mati itu sebagai s eo rang wasi dan bukannya sebagai
benef is ian dan hendaklah membahagi-bahagikan kredit
itu mengikut Undang-undang Islam.
KEGUNAAN KWSP SAHAJA
KP
HURUFAWALAN
NAMAAHU
MOD PEMBAYARAN
WARAN
DRAF8ANKASING
ARAHAN1 BAYARAN
KREDITKEAKAUNBANK
1
2
3
4
DISEMAKOLEH
PEGAWAIPENYEMAK
NO K/TGN
U_LTARIKri
DISAHKANOLEHPEGAWAIPENGESAH
TARIKH
DILULUSKANOLEH:PEGAWAIPEI.U1.US1
NO K/TGK
I I ITARIKH
INO
IK/TGN
I I I
DILULUSKANOLEHPEGAWAIPELULUS2
1TARIKH
NO K/TGN
1 1 1
1. NOMBORAHU
! I I3 NOMBORKADPENGENALAN7DIGIT
• I I I I
BUTIRAN AHLI
2 NOMBOR KAD PENGENALAN12 DIGIT
I II I4 NOf/BORPOUS/TENTERA/PASPORT/DSB
I I I I I |
I
I5. NAMA MENGIKUT KAD PENGENALAN/PASPORT
i I II I I
II
I II I
T1
11 II 1
6 SEKTOR KERAJAAN 7.JANTINA
BEKERJASENDIRI
KERAJAAN
SWASTA
TIDAK BEKERJALILFLAKI PEREMPUAN
KETURUNAN 9 AMAUN YANG DIPOHON• RINGGIT MALAYSIA
1X11UJSEN
10 ALAMATAHLI
[ TTTTTT I T n
r i IT T T l I 1 1 I 1 1 I I I I I I IPOSKOD BANDAR
LJLLXXlLi IT 1NEGERI
rTXT"rrrT~rn~rT
I T I I I I 1
TTT11. NOMBOR TELEFON PEJABAT
n T I I I INOMBOR TELEFON RUMAH/EIMBIT
L l I I I I F T ZADALAH SAYA DENGAN INI MENGAKU JAN Jl SEPERTIBERIKUT1 MEMATUHI SEMUA SYARAT YANG DIKENAKAN OLEH LEMBAGA Dl BAWAH SKIM IN' DAN MEMAHAMIDENOAN PEMIUHAN INI LEMBAGA TIDAK AKAN
BERTANGGUNGJAWAB KE ATAS APA APA KLEMBAGA Dl ATAS KERUGIAN TERSEBUT
2 APA-APA AMAUN YANG OIPINDAHKAN TIDAK TERMASUK DALAM PENAMAAN SAYA3 SAYA JUGA FAHAM BAHAWA SAYA TIDAK BOLEH MEMBATALKAN PSRVOHONAN INI
12.
JENIS PENGELUARAN
NOMBOR AHLI
CAP IBU JARI KIRI
DAN KANAN AHLI
(MESTI DITURUNKAN
DENGAN TERANG
DAN PENUH
MENGGUNAKAN
PAD CAP IBU JARI
BERWARNA HITAM)
TARIKH
• NOMBOR
KIRl KANAN
13. UNTUK DIISI OLEH INSTITUSI PENGURUSAN DANA (IPD)
KOD INSTITUSI PENGURUSAN DANA (RUJUK PANDUAN MENGISI BOR« NG)
NOMBOR AKAUN/NO RUJUKAN PEMOHON LHH
SAYA DENGAN INI MENGESAHKAN MAKLUMAT PDviOHON Dl ATASi i i i i i i i i
TANOATANGAN NAMA PEGAWAI COP RASMI
TARIKH
PANDUAN UNTUK MENGISI BORANG KWSP 9F (AHL)PEMBERITAHUAN PEMINDAHAN KREDIT UNTUK SKIM PELABURAN
SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG BORANG PERMOHONAN MESTILAHDIPENUHI DENGAN HURUF BESAR.
Nombor Ahll
Isikan sata digit di setiap ruang dengan didahului oleh dig.t '0' jika perlu seperti contoh di bawah
Contoh 1234567
1. NOMBOR AHL!r — r
3 4 , 5 6
2. Nombor Kad Pengenalan 12 Digit
Isikan nombor Kad Pengeiialan 12 digit tuan/puan Jlka tuan/puan belum memiliki Kad Pengtnalan 12digit, kosongkan rtiangan ini
2. NOMBOR KAD PENGENALAN
Contoh 610701-02-6157 6 1 0 1 7 , 0 1 0 1 I 5
3. Nombor Kad Pengenalan 7 Digit
Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah
a) 1234567
b) A 1234567
c) K 1234567
d) H 1234567
3 . NOMBOR KAD PENGENALAN 7 DIGIT1
3 4 , 5 6
3 4
3 4
3 , 4
5
5
6
6
4- Nombor Polis/Tentera/Pasport/Dsb
Isikan Nombor Polis/Tentera/Pasport/Dsb termasuk huruf awalan, seperti contoh di bawah
4. NOMBOR POLIS/TENTERA/PASPORT/DSB
a' I 1234567
b) T 1234567
* S 6 | 7
5 (5 7
5. Nama Mengikut Kad Pengenalan/Pasport
Tuliskan nama tuan/puan seoagaimana yang tercalat dalam kad pengenalan tuan/puanJlka sama menglkut kad pengenalan ialah Norman bin Abdullah sila tuliskan nama seperti di bawah
5. NAMA MENGIhUT KAD PENGENA1 AN/PASPORI
N O R ' M ' A I N N B D H1_
6. Sektor Pekeriaan
Tandakan ( V ) di dalam ruang yang disediakan. Jlka tuan/puan bekerja dalam sektor swasta, tandakan( V ) dalam ruang berkenaan sepertl di bawah :
?• SEKTOR PEKERJAAN
BEKERJA SENDIRI I
KERAJAAN
SWASTA
TIDAK BEKERJA
7- Jantina
Tandakan jantina tuan/puan dengan ( V ) dalam ruang yang disediakan. Jika lelaki, tandakan (V) di ruangyang berkenaan seperti di bawah :
7. JANTINA LELAKI PEREMPUAN
8. Keturunan
Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, Isikanseperti di bawah :
8. KETURUNAN 1
MelayuCinaIndiaLain-lain
1234
BidayuhKadazanIban
567
9. Amaun Dipohon
Isikan satu digit di setiap ruang dengan didahului oleh digit-digit '0' jika perlu. Jika amaun yang dikehendakioleh tuan/puan untuk pemindahan pelaburan (setelah berunding dengan IPD) adalah RM13,170.00, isikanruangan yang berkenaan seperti di bawah :
9. AMAUN DIPOHON
RINGGIT MALAYSIA SEN
0 0 0 0
10. Alamat Ahli
Tuliskan alamat surat menyurat tuan/puan dengan lengkap. Jika alamat surat menyurat tuan/puan adalahLot 10 Kg Parit Kadir Timur, Bukit Pasir, 84300 Muar, Johor Daru) Takzim, sila penuhl seperti berikut :
10. ALAMAT AHLI
L
T
O
I
T
M
POSKOD
8 4 3
NEGERI
J O H
U
0
o
1
R
0
0
R
B
K
U
G
K
BANDAR
M
D
U
A
A
R
I
R
U
P
T
A
L
R
P
T
I
A
A
T
S
K
I
Z
K
R
I
A D I R
M
11. Nombor Telefon
Isikan nombor telefon di ruangan yang disediakan dl bawah :Contoh : Nombor Telefon Pejabat : 07 - 9859450 Nombor Telefon Rumah/Blmbit : 016 - 2070158
11. TELEFON PEJABAT8 _ L L L L I I I
TELEFON RUMAH/BIMBIT
- ! 2 0 7 0 1 5 8
12. Jenis Fengeluaran. Nombor Ahli. Nombor Kad Pengenalan dan Cap lbu Jar!
Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanantuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jarl berwarna hltam.
13. BUTIRAN UNTUK DIISI OLEH INSTITUSI PENGURUSAN DANA
i. Kod Instltusi Pengurusan Dana
Isikan kod yang telah diperuntukkan oleh KWSP kepada Institusl Pengurusan Dana (IPD) :Contoh : Kod 'AIM Unit Trust Bhd" ialah 007
Isikan seperti berikut di kotak yang berkenaan D 0 0
Nombor Akaun / Nombor Rujukan Pemohon
Tullskan nombor akaun / nombor rujukan yang diperuntukkan oleh IPD kepada pemohon.Contohnya : Jika nombor akaun pelaburan pemohon ialah 123456789100001, isikan ruanganseperti di bawah :
LI 8 9 1 0 0 0 ' 0
HI. Pengesahan Nombor Pollsl / Nombor Rujukan Pemohon
Turunkan tandatangan, tuliskan nama pegawai dan cop rasmi IPD serta tarikh pengesahan di ruanganyang disediakan.
n
NAMA
NO. AHLI TEL:(P) (R),
1.0 PENTING
11 Borang permohonan yang telah lengkap diisi hendaklah diserahkan kepada Institusi Pengurusan Dana(IPD) yang dplih
1 2 Salman dokumen hendaklah disahkan oleh pegawai Institusi Pengurusan Dana (IPD) yang dipilih
1 3 Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam Tuan/puan hendaklahmenurunkan cap ibu jan kin dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Janberwarna hitam
1 4 Tuan/puan hendaklah memastikan dokumer dokumen yang disertakan bersama-sama dengan borangpermohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples)
1 5 Semua sahnan fotostat dokumen hendaklah menggunakan kertas saiz A4
1 6 KWSP berhak menolak mana-mana permohonan yang tidak lengkap
2.0 DOKUMEN UTAMA
Tandakan (V ) dalam kotak yang berkenaan
2 1 Borang permohonan KWSP 9F(AHL) - 3 Salman
(1 sahnan disimpan oleh IPD dan 2 salinan untuk kegunaan KWSP)
2 2 Salman Kad Pengenalan ajau
Salman Kad Pengenalan Polis/Tentera danSurat Pengesahan Majikan menyatakan nombor Kad Pengenalan Awam aannombor Polis/Tentera merujuk kepada orang yang sama
Tandatangan Ahli
Tandatangan Penenma
Tankh
Tankh
KUMPULAN WANG SIMPANAN PEKERJA1OGOS2001
KEGUNAAN KWSP SAHAJA
KPD E
HURUFAWALAN
NAMAAHU
MODPEMBAYARAN
WARAN
DRAFBANKASING
ARAHAN8AYARAN
KREDITKE AKAUN BANK
1
23
4
JENIS AKAUN
KONVENSIONAL
AL-WADIAH
12
PENERiMABAYARAN
AHLI
INSTlTUSIPENGAJIANTiNGG!
INSTITUSIPEMBERIPINJAMAN
1
2
3
DISEMAKOLEH:PEGAWAIPENYEMAK
CAW UNIT
1
NO. K/TGN
TTTI
TARIKH.
JENIS PENGELUARAN YANG DIPOHON: SILA TANDAKAN ( V ) Dl KOTAK YANG BERKENAAN
1. JENIS PENGELUARAN
1
2
PENDIDIKAN
PENDIDIKAN ANAKAHU
2.NOMBORAHLI
4. NOMBORKADPENGENALAN7DIGIT
6. KETURUNAN•
BUTIRAN AHLI
3, NOMBOR KAD PENGENALAN 12 DIGIT
rrrr\ i I-I i i -i i
5. NOMBOR POUS/TENTERA/PASPORT/DSB
niTTTT I I I ! I I
7.JANTINA
LELAKI
PEREMPUAN
8. NAMA MENGIKUT KAD PENGENAUN PASPORT
I I I I I I I I I I I9.ALAMATAHU
i n i i nPOSKOD BANDAR
TTTTl rrrrNEGERI
r m i i i i i i i i i TTITTTT M I N I
10. NOMBOR TELEFON PEJABAT NOMBOR TELEFON RUMAH/BIMBIT
I I I I I I I I
11. YURAN PENGAJIAN AHLI/ANAK AHLI
RINGGIT MALAYSIA
I I I I I ISEN
12
I I I
. AMAUN DIPOHON UNTUK AHLI/ANAK AHLI
RINGGIT MALAYSIA
I I I I ISEN
I
13. BAKIFINJAMAN PENDIDIKAN AHLI/ANAK AHLI 14. JENIS PEMBAYARAN
RINGGIT MALAYSIA
I I I I I ISEN
IWARAN
DRAFBANKASING
ARAHANBAYARAN
KREDITKE AKAUN BANK
BUTIRAN AKAUN BANK (SEKIRANYA PEMBAYARAN DIBUAT KEPADA AHLI)
16. KOD BANK 16. NOMBOR AKAUN BANK AHLI
i i ' i i i i i i i i i i i i i i i i i i i n
17. JENIS AKAUN
KONVENSIONAL
AL-WADIAH
PEMBERITAHUANDISAHKANOLEH
PEGAWAIPENGESAH
NO K/TGN
TARIKH
DILULUSKANOLEHPEGAWAI PELULUS1
NO K/TGN
TARIKH
PEGAWAI PELULUS 2
NO K/TGN
TARIKH
BUTIRAM PELAJAR (ANAK AHLI) (SEKIRANYA MEI1OHON UNTUK PENDIDIKAN ANAK)
niErn18 NAMA PELAJAh Mf-Nbirs(JT KAD PENGENALAN
TTTTTTT
19 NOMBOR KAD PENGENAIAN 12 DIGIT
20 HUBUNGAN AH J DENGAN PELAJAR ANAK AMAKTIRI ANAK ANGKAT
BUTIRAN LAIN
i21 JAMA DAN CAWANGAN INSTITUSI PCNGAJIAN TINGGI
Ii I I I I I I
22 PERINGKATPENGAJIAN P I 23 TAHUN PENGAJIAN H I 24 LOKASI PENGAJIAN •25 NAMA PAN CAWANGAN INSTITUSI DFMBERI PINJAMAN
1X1 II
1 SAYA DENGAN INI MEMOhON UNTUKMENGELUA^KAN KREDITSAYADI KWSPtv'ENURUTPERUNTUKANAKTAKWSP 1991 SAYA JUGAAKANPATUHKEHLNDAK SEKCYCN 54(6)(G) PERUNTUKAN AKTAKWSP 1991
2 SAYA MEMBFt ARK AN KWSP MEMBUAT BAYARAN TER JS KEPADA INSTITUSI PFNGAJIAN TINGGI ATAU PEMBERI PIN JAMAN Dl MANA YANGBERKtNAAN
26
JENIS PENGi-LUARAN
NOMBOR AHII
CAP IBU JARI KIRI
DAN KANAN AHLI
(MESTI DITURUNKAN
DENGAN TERANG
DAN PENUH
MENGGUNAKAN
PAD CAP IBU JARI
BERWARNA HITAM)
TARIKH _
I • NOMBOR
KIRI KANAN
PANDUAN UNTUK MENGISI BORANG KWSP 9 H fAHLlPENGELUARAN PENDIPIKAN ANAK
SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAHDIPENUHI DENGAN HURUF BESAR.
1.
2.
Jenis Pengeluaran Yang Dipohon
Tandakan ( V ) dlmana berkenaan 1. JENIS PENGELUARAN
1.
2.
PENDIDIKAN AHLI
PENDIDIKAN ANAK AHLI
Nombor Ahli
Isikan satu digit di setiap ruang dengan didahului oleh digit '0' jika perlu, seperti contoh di bawah
Con ton : 01234567
2. NOMBOR AHLI1 [_2 3 4 5 6 7
3. Nombor Kad Pengenalan 12 Digit
Isikan nombor Kad Pengenalan 12 digit tuan/puan. Jika tuan/puan belum memiliki Kad Pengenalan 12digit, kosongkan ruangan ini :
Contoh : 610701 - 02 - 6157
3. NOMBOR KAD PENGENALAN 12 DIGIT
o | 7 | o o
4. Nombor Kad Pengenalan 7 Digit
4.1 Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf avvalan, seperti contoh di bawah:
4. NOMBOR KAD PENGENALAN 7 DIGIT
a) 1234567
5 .
1 i 2 [ 3 ' 4 fs \ 6~J~7
b)
c)
d)
Nombor
A
K
H
1234567
1234567
1234567
Polis/Tentera/Pasport/Dsb
3 4 1~5 ] 6 F 7
[K T]2
1 I 2 ! 3 4 | 5 6 [ 7
Isikan Nombor Kad Pengenalan Polis/Tentera/Pasport/Dsb tennasuk huruf awalan, seperti contoh di bawah:
5. NOMBOR/POLIS/TENTERA/PASPORT/DSB
HIDa)
b)
I 1234567
T 1234567
6. Keturunan
Isikan ruang dengan menglkut kod keturunan di bawah lnl. Jika tuan/puan berketurunan Melayu, isikanseperti di bawah :
567
6. KETURUNAN| 1
MelayuCinaIndiaLatn-lain
1234
BidayuhKadazanlban
7.
Tandakan jantina tuan/puan cU ngan ( \ ) dalain ruang yang disediakan Jika lelaki tandakan ( V ) di ruangyang berkenaan seperti di bawah
7 JANTINA
IELAKI
I'F REMPUAW
Nama Mengikut Kad Pengenalan/Pasport
Tuhskan nama tuan/puan sebagaimana yang tercatat dalam kad pengenalin tuan/puanJika sama mengikut kad pengf nalan ulah Norman bin Abdullah sila tuhskan nania seperti di bawah
8. NAMA MENGIKUT KAO I 1 NGENAI AN/P<\SPORT' ] O | R T M7~A^~N I ] B 1 N A B | D U L ] L |~A ' H ' ^
9. Alamat Ahli
Tuliskan alamat surat menyural tuan/puan dcngan lengkap Jika ilamat surat menyurat tuan/puan adalahLot 10 Kg Parit Kadir Timur Bukit Pasir 84300 Muai Johor Darul Tak/im Sila penuhi seperti berikut
9 ALAMAT AHLIL i O T 1 0 K[ G P A R I T r K A
1 I I M | U I R I
POSKOD~8 4 ' 3}
NEGERI
^ , HTOI R!
_B J U K I I
B A N D A R
M1 U [ A I R
P A S 1 R 11 1
j Q _J.T D
10 . Nombor Telefon Pejabat & Nombor Telefon Rumah
Isikan nombor telefon pejabat dan uimah di ruangan yang disediakan di bawahContoh Nombor Telefon Pejabat 07 9859450 Nombor Telefon Rumah/ Bimbit 0 1 6 - 2 0 7 0 1 5 8
10. TELEFON PEJABA10 ' 7 r q T 8 T ¥ " 9 ^ 4 5 0
TELEFON RUMAH 'BIMB1T0 i 1 ' 6 2 , 0 7 0 1 5
11 Yuran Pengajian Ahli/Anak
Isikan satu nombor untuk Uap tiap satu ruangan Nombor kosong (0) di hadapan perlu dituhskan dalamsemua ruangan yang tidak dipenulu Jika yuian pengajian t u a n / p u a n atau anak t u a n / p u a n adalahRM12 000 00, isikan ruangan \ang bei kenaan sepeiti di bawah
11 MIRAN I'ENGA.JIAN AHLI/ANAK
RINGGIT MALAYSIA T SEN
0 0 1J 2 l 0 0 I 0 Jo_O I
12. Amaun Dipohon
Isikan satu nombor untuk tiap-tlap satu ruangan. Nombor 'kosong' (0) di hadapan perlu dituliskan dalamsemua ruangan yang tidak dipenuht. Jika tuan/puan memohon RM 10,000.00, isikan ruangan yang berkenaanseperti di bawah :
12. AMAUN DIPOHON
RINGGIT MALAYSIA SEN
_OJ 0 | 1 | 2 j 0 | 0 J 0 | 0 0
13. Baki Piniaman Pendidikan Ahli/Anak Ahli
Isikan satu nombor untuk tiap-tiap satu ruangan. Nombor 'kosong' (0) di hadapan perlu dituliskan dalamsemua ruangan yang tidak dipenuhi. Jika tuan/puan memohon RM10.000.00, isikan ruangan yang berkenaanseperti di bawah :
13. BAKI PINJAMAN PENDIDIKAN AHLI/ANAK AHLI
RINGGIT MALAYSIA I SEN
[ Oj_ 0J_1 | 0 0 0 j 0 ' 0 I 0
14. Jenis Pembayaran
Tuan/puan boleh memilih salah satu cara pembayaran sepcrti berikut . Jika tuan/puan memllih Kredit KeAkaun Bank, sila tandakan ( V ) di ruangan yang berkenaan :
14. JENIS PEMBAYARAN
ARAHAN BAYARANWARAN
DRAF BANK ASING KREDIT KE AKAUN BANK
IS. Kod Bank
16.
Isikan kod bank tuan/puan seperti contoh di bawahJika kod bank tuan/puan adalah Maybank
15. KOD BANK
RHB BankMaybankBumiputra CommercePublic BankHong Leong BankHong Leong FinanceAffin BankEON Bank
Nombor Akaun Bank
010 20 30 405060 70 8
Arab Malaysian Bank - 09Alliance Bank - 10Southern Bank - 11Utama Bank - 12Bank Muamalat 13Arab Malaysian Finance • 14BanL Islam - 15
Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah
16. NOMBOR AKAUN BANK
1 4 6 . 8 0
17. Jejiis Akaun
I s i k a n )( m-- a k a u n vans.1 l ipihl nh 1 in p u i'i i k i m a n p u tu inf in i l i l i Ak u r n Al W a d i a h Mia l u u d a k i 1( ) r|i m ms jan \ a n e be i K> i> i n
1 7 , ) E \ ' I S AKAUN
K O N V F N S I O N A L •
AI W A D I A H
18, Nama Pelaiar (Anak Ahlii
Tuhskan nama anak t u a n / p u a n Mba^annana >ang u n a t a t dalam kail p< ngenalan anak t u a n / p u a n Jikanama mengikut kad p e n g t n a l m lalah Muliamad bin Nounan, sila tuliskan aarna sepeiti di bawah
18 . KAMA I I I AJAK (ANAK AUI I)
M U H A M M A D I 1 \ \ O K M A N
19 Nombor Kad Pengenalan Pelajar
I s i k a n n o m b o r K a d P m f t t i i i l a i i ' d ^ n i n iK t u i n | i\d{]C o n t o h 7 8 1 1 0 5 0"! <>li>f->
1 9 . N O M B O R K A D P E N ( , I \ / \ ) ^ I ' l I V J A R
7 8 1 1 0 5 OS i) 1 b ()
2 0 . Hubungan Ahli Dengan Pelaiar
l a n d a k a n h u b u n g a n a h l i d i n t i n p i i | a i ( a i n k t m m p u a n d i n i a n g a n \ a n g d i s c d i a k a nC o n t o h s e k i r a n v a h u b u n n a n i h l i d< i i " i n p c l a i a i id i l a h i n a k k a n d u n g
2 0 . H U B U N G A \ M i l 1 1)1 \ ( , A N I I I A I \ R
\ N \ K v \ \ \ K ! <K\ W \ K \ \ ( . k \ l
21 . Naima Dan Cawangan Institusi Pengajian Tinggi
Tul iskan n a m a dan cawangan intiiuM pcnj,a]ian tmggiContoh iika n a m a m s t i t u s i pi n»an<ui tmg^i t u a n / p u a n a t a u a n a k t u a n / p u a n m l a h Ui lM S h a h Alamisikan scpert i di bawah
2 1 . NAMA DAN CAWANGAN IKSriTUSI PLNGAJIAN TINGGIU l 1 Ml T s H A II A I A M
22 . Peringkat Pengajian
I n l i s k i n penngka t p t n g a i n n l u u i pu \n u a u anak m a n p u a n nioiigikul kod sepei t i di bawah
2 2 . I F RINGKAI PI NGA.JIAN
I]a/ah 1 Ija/ah I anpii in ; l a m I n n ^ a I t c. S e t i n f 3 Diploma i 4
23. Lokasi Pengaiian
Tuliskan lokasi pengajian tuan/puan atau anak tuan/puan mengikut kod seperti di bawah
Dalam Negara 1 Lur Negara
24. Nama Dan Cawangan Institusi Pemberi Piniaman (Jlka Ada)
Tuliskan nama dan cawangan institusi pemberi pinjaman dengan lengkap
24. NAMA DAN CAWANGAN INSTITUSI PEMBERI PINJAMANM B | F
P E [ T
F
A L
I
I
N
N
A N C
G| | J
E
A
B
Y A
H D |
i
25. Jenis Pengeluaran. Nombor Ahll. Nombor Kad Pengenalan Dan Cap Ibu Jari
Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari klri dan kanantuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.
NAMA
NO. AHLI TEL:(P) (R).
10. PERHATIAN
1 1
12
13
14
15
16
17
Sekiranya permohonan diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannya bagitujuan pengesahan oleh Pegawai KWSP
Sekiranya tuan/puan mengemukakan salinan dokumen sahaja, sila pastikan semua sahnan dokumen telahdisahkan oleh pegawai yang dibenarkan oleh KWSP seperti berikut lengkap dengan nama dan cop rasmipengesah (kecuali salinan dokumen-dokumen tertentu yang telah ditetapkan PegawaiPengesahnya oleh KWSP):-
1 21 Pegawai KWSP yang terdiri danpada 1 2 5- Pegawai KWSP Gred 18 ke atas 1 2 6- Pegawai Kaunter KWSP 1 2 7
1 2 2 Majikan Pemohon 1 2 81 2 3 Penghulu atau Penggawa 1 2 9124 Jaksa Pendamai 1210
Pengamal Perubatan yang berdaftarPenguambeladan PenguamcaraKumpulan Pengurusan/Profesional KerajaanAhli Dewan Undangan NegenAhli ParlimenPesuruhjaya Sumpah
Sekiranya permohonan bersama, sila sediakan 1 set dokumen bagi setiap permohonan
Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam Tuan/puan hendaklahmenurunkan cap ibu jan kin dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Janberwarna hitam
Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-bersama denganpermohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples)
Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4
KWSP berhak menolak mana-mana permohonan yang tidak lengkap
2.0. DOKUMEN UTAMA
Tandakan (V) dalam kotak yang berkenaan
2 1 PENGELUARAN PENDIDIKAN AHLI
2 1 1 Borang permohonan KWSP 9H (AHL) - 2 salinan
2 1 2 Borang KWSP 3A (AHL) -1 salinan
2 1 3 Salman Kad Pengenalan ahli atau.
Salman Kad Pohs/Tentera dan Surat Pengesahan Majikan menyatakannombor Kad Pengenalan Awam dan Nombor Pohs/Tentera merujuk kepadaorang yang sama,
21 4 Sekiranya pembayaran dibuat kepada ahli, sila kemukakan salinan mukahadapan Buku Akaun Bank yang mempunyai butir-butir akaun tuan/puanatau Penyata Akaun Semasa yang asal Pemohon hendaklah menurunkancap ibu jan km dan kanan di atas salinan tersebut Sekiranya tuan/puanmenghantar melalui pos, salinan dokumen hendaklah disahkan olehPegawai Bank berkenaan dan sek>fanya diserahkan di kaunter silakemukakan dokumen asal beserta salinannya bagi tujuan pengesahanoleh Pegawai Kaunter KWSP
r
•
2.1.5. Surat tawaran kemasukan ke Institusi Pengajian Tmggi (merujuk Tahun 1,2,3dan seterusnya)(Sekiranya salman surat tawaran dikemukakan, hendaklah disahkan oleh PegawaiIPTyang diben kuasa atau Pegawai KWSP seperti di para 1.2.1)
2 1 6. Surat pengesahan yang mengesahkan jumlah yuran pengajian yang dikeluarkanoleh Institusi Pengajian Tmggi yang mengandungi butiran:
(a) Nama dan nombor kad pengenalan ahli(b) Jems kursus di penngkat Diploma ke atas(c) Tahun pengajian
2.2 PENGELUARAN PENDIDIKAN ANAK AHLI
2 2 1 . Borang dan dokumen seperti para 2 1 . 1 - 2 1 4
2.2 2. Salinan Kad Pengenalan Anak Ahli
2.2 3. Salman SIJII Kelahiran AnaK/Sijil Pengesahan Anak Angkat / SIJII Perkahwinan(bukti pertahan bagi anak tin)
2 2 4. Surat tawaran kemasukan ke Institusi Pengajian Tmggi (merujuk Tahun 1, 2,3dan seterusnya)(Sekiranya salinan surat tawaran dikemukakan, hendaklah disahkan oleh PegawaiIPTyang diben kuasa atau Pegawai KWSP seperti di para 121)
2.2.5. Surat pengesahan yang mengesahkan yuran pengajian yang dikeluarkan olehInstitusi Pengajian Tmggi mengandungi butiran • -
(a) Nama dan nombor kad pengenalan anak ahli(b) Jems kursus di penngkat yazah, yazah lanjutan atau yang setaraf dengannya
untuk ahli di Institut Pengajian Tmggi yang berkenaan(c) Tahun pengajian
3.0. DOKUMEN TAMBAH AN
3.1 Pembayaran Kepada Institusi Pengajian Tmggi Dalam Negara
Bagi Permohonan Ahli/Anak Dalam Tahun Pertama
(i) Surat pengesahan pendaftaran danpada Institusi Pengajian Tmggi
a) Nama dan nombor kad pengenalan ahli/anak ahlib) Jems kursus di penngkat Diploma ke atas untuk ahli dan di peringkat ijazah,
ijazah lanjutan atau yang setaraf dengannya untuk anak ahli di InstitusiPengajian Tmggi yang berkenaan
c) Tahun pengajian
3.2 Pembayaran Kepada Ahli Di Mana Ahli/Anak Ahli Mengikuti Pengajian Di Institusi PengajianTmggi Luar Negara
(i) Pasport I I
(n) Visa pelajar (jika berkenaan)
3.3. Pembavaran Balik Kepada Ahli
(i) Resit pembayaran yuran pengajian yang tidak melebihi 1 tahun dan tankhpermohonan.(Sekiranya salinan resit pembayaran dikemukakan, hendaklah disahkan olehPegawai IPTyang diben kuasa atau Pegawai KWSP seperti di para 1 2.1)
23. Lokasi Pengalian
Tullskan lokasi pengajiP.n tuan/puan atau anak tuan/puan mengikut kod seperti dl bawah
Dalam Negara 1 Lur Negara I
24. Nama Dan Cawangan Institusi Pemberi Pinjaman (Jika Ada)
Tuliskan nama dan cawangan tnstltusi pemberi ptnjaman dengan lengkap :
24. NAMA DAN CAWANGAN INSTITUSI PEMBERI PINJAMANM B F F I N A N I C [ E B H D
P E T A L I N G J A Y A ZULU I
25. Jcnis Pengeluaran. Nombor Alili. Norabor Kad Pentfcnalan Pan Cap lbu Jari
Isikan jenis pengeluaran, nombor anil, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanantuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.
KEGUNAAN KWSP SAHAJA
HURUFAWALANNAMAAHLI
MOD PEMBAYARAN
WARAN
DRAFBANKASING
ARAHANBAYARAN
KREDITKE AKAUN BANK
1
2
3
4
JENIS AKAUN
KONVENSIONAl
AL WADIAH
1
2
AMAUN OIBAYAR
RINGGIT MALAYSIA
I I I I ISEN
KODPENERIMABAYARAN
AHLI
PUSATPERUBATAN
1
2
DISEMAKOLEHPEGAWAIPENYEMAK
CAW UNIT
I
ITARIKH
NO
IK/TGN
I I
1 NOMBORAHLI
I I I I IT I 13 NOMBORKADPENGENALAN7DIGIT
BUTIRAN A H L I
2 NOMBOR KADPENGENALAN12 DIGIT
I I I I4 NOMBOR POLIS/TENTERA/PASPORT/DSB
I I I I \ IT I I I I I5 KETURUNAN
7 JANTINA
6 NAMAMENGIKUTKAD PENGENALAN/PASPORT
r i i i i 1 I T T I I I 1 IFTTI I M T\ I I I I
LELAKI
PEREMPUAN
I PERBELANJAANPERUBATAN
PERBELANJAAN SEBENAR / ANGGARAN
9 KOS DIBIAYAIOLEH MAJIKAN
RINGGIT MALAYSIA
I I I I ISEN RINGGIT MALAYSIA
I I I ISEN
I10 ORANG MENERIMA RAWATAN
1 AHLI 3ENDIRI
2 SUAMI
3 ISTERI
4 IBU
5 BAPA
6 ANAK
7 ADIK BERADIK
8 ORANG YANG DILULUSKAN
OLEH LEMBAGA
11
TNAM^ ORANG YANG MENERIMA RAWATAN (JIKA BUKAM AHLI SE NDIRI)
I I I T T I II I I I I I I I
12 NO KADPENGENALAN/SIJILKELAHIRANORANC YANG MENERIMA RAWATAN
I I I I I\
13
I II I
I II I
I II
I I I I I I I I I I
ALAMATAHLI
I III
I IM
POSKOD BANDAR
IT IN TNEGFRI
I I I I I I I I I I I
LL I I I I I I i n i i i i
14.
II
NOMBOR TELEFONPEJABAT
T INOMBOR TELEFON RUMAH/BIMBIT
I I I
15 JENIS PEMBAYARAN
WARAN
DRAFBANKASING
ARAHANBAYARAN
KREDITKE AKAUN BANK
BUTIRAN AKAUN BANK (SEKIRANYA PEMBAYARAN DIBUAT KEPADA AHLI)
16 KODBANK 17 NOMBOR AKAUN BANK
JLU I I I I I ITTT l i n I TTI I I18 JENIS AKAUN
KONVENSIONAL
AL WADIAH
NOMBORAHU E NOKAOPENGENALAN
F T I I I I J U T I I J.JEMSPENCELUARAN
BUTIR-BUTIR PESAKIT
1 NAMA SUAMI / ISTERI YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA SILA NYATAKAN NAMA PENUH, NO KAD PENGENALAN DAN UMUR
(POTONG Dl MANA TIDAK BERKENAAN)
NAMA MENGIKUT KAD PENGENALAN NO KAD PENGENALAN UMUR
in)
IV)
2 NAMA ANAK-ANAK YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA, SILA NYATAKAN NAMA PENUH, JANTINA, NO KAD PENGENALAN DAN
UMUR
NAMA MENGIKUT KAD PENGENALAN JANTINA NO KAD PENGENALAN UMUR
in)
3 NAMA IBU / BAPA YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA, SILA NYATAKAN NAMA PENUH, JANTINA, NO KAD PENGENALAN DAN
UMUR
NAMA MENGIKUT KAD PENGENALAN JANTINA NO KAD PENGENALAN UMUR
4 NAMA ADIK-BERADIK YANG BERUMUR 16 TAHUN KEATAS YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA SILA NYATAKAN NAMA PENUH,
JANTINA, NO KAD PENGENALAN DAN UMUR
NAMA MENGIKUT KAD PENGENALAN JANTINA NO KAD PENGENALAN UMUR
i)
II)
IV)
PEMBERITAHUANDISAHKANOLEH:
PEGAWAIPENGESAH
NO K/TGN
Mil l
TARIKH
DILULUSKANOLEH:PEGAWAIPELULUS1
NO K/TGN
1ARIKH
PEGAWAIPELULUS2
NO K/TGN
I I I I I
TARIKH
BUTIRAN HOSPITAL / INSTITUSI PERUBATAN / KESIHATAN
19.
i I I I INAMA HOSPITAL / INSTITUSI PERUBATAN / KESIHATAN
I I I I I I IMi l l I I I I I I I I
I I II I I
20. ALAMAT HOSPITAL /INSTITUSI PEflUBATAN / KESIHATAN
II
I I I I I I II I I I I I I
I I IM M
II I I I I III II I I I II
POSKOD BANDAR
i i i i i iNEGERI
LL 1 1 1 I I I I I I T I I T I T I I I
1. SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTAKWSP 1991.
2 SAYA BERSETUJU SUPAYA JUMLAH KREDIT YANG DIKELUARKAN DARI AKAUN SAYA DIBAYAR TERUS KEPADAHOSPITAL/INSTITUSI PERUBATAN/KESIHATAN MENGIKUT JUMLAH DALAM BIL YANG OIPERSETUJUI OLEH SAYA(JIKA AHLI MENGGUNAKAN SURAT JAMINAN KWSP UNTUK MENERIMA RAWATAN)
21.
JENIS PENGELUARAN
NOMBOR AHLI
CAP IBU JARI KIRI
DAN KANAN AHLI
(MESTI DITURUNKAN
DENGAN TERANG
DAN PENUH
MENGGUNAKAN
PAD CAP IBU JARI
BERWARNA HITAM)
TARIKH-
H NOMBOR
KIRI KANAN
PANDUAN UNTUK MENGISI BORANG KWSP 9D (AHL)PEMBERITAHUAN PENGELUARAN KESIHATAN
SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAHDIPENUHIDENGAN HURUF BESAR.
1. Nombor Ahll
Isikan satu digit di setiap ruang dengan didahului oleh digit '0' jiKa perlu, seperti contoh di bawah
Contoh : 1234567
1. NOMBOR AHLI
4.
5 .
0 1
Nombot Kad Pengenalan 12 Digit
Isikan nombor Kad Pengenalan 12 digit tuan/puan. Jika tuan/puan belum memilikl Kad Pengenalan12 digit, kosongkan ruangan ini :
Contoh : 610701-02-6157
2. NOMBOR KAD PENGENALAN 12 DIGIT
o 0 1 0 1
Nombor Kad Pengenalan 7 Digit
Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah :
3. NOMBOR KAD PENGENALAN 7 DIGIT
a)
b)
c)
d)
1234567
A 1234567
K 1234567
H 1234567
Nombor Polls/Tentera/Pasport/Dsb
Isikan Nombor Kad Pengenalan Polls/Tentera/Pasport/Dsb termasuk huruf awalan, seperti contoh di bawah
4. NOMBOR POLIS/TENTERA/PASPORT/DSB2
2
3
3
4 5
" 4~1 5 "
6
6
7
7
a) I 1234567
b) T 1234567
Ketnrunan
Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, isikanseperti di bawah :
5. KETURUNAN [ 1
MelayuCinaIndiaLain-lain
1234
BidayuhKadazanIban
567
6. Nama Mengikut Kad Pengenalan/Pasport
Tuliskan nama tuan/puan sebagaimana yang tercatat delam kad pengenalan tuan/puan. Jlka nama mengikutkad pengenalan ialah Norman bin Abdullah, sila tuliskan nama seperti di bawah :
N O R M
6. _NAMA MENGIKUT KAD PENGENALAN/PASPORT
^ N rB I I N A B D U ! L
1JLH
7. Jantina
Tandakan jantina tuan/puan dengan K) dalam ruang yang disediakan Jika lelaki, tandakan K) di ruangyang berkenaan seperti di bawah
7. JANTINA
LELAKI
PEREMPUAN
Perbelanjaan Perubatan
Sebenar/anggaran ialah bil perubatan yang telah atau akan dikenakan oleh pusat rawatan yang diktiraf.Kos rawatan akan dikenakan oleh pusat rawatan yang diiktiraf. Jika kos rawatan yang dikenakan untukpenyakit kanser ialah RM 10.000 00, isikan seperti di bawah
8. PERBELANJAAN PERUBATAN
SENRINGGIT MALAYSIA
0 0 1 0 0 0 0 0 0
9. Kos Yang Dibiavai Oleh Maiikan
Kos rawatan yang dibiayai oleh majikan. ContohnyaKos rawatan pesakit (isteri) RM 10,000.00Biayai majikan: RM 4,000.00Isikan seperti berikut .
9. KOS YANG DIBIAYAI OLEH MAJIKAN
RINGGIT MALAYSIA
0 0 0 4 0 0 0
SEN
0 0
10. Orang Yang Menerima Rawatan
Tandakan hubungan pesakit dengan pemohon di ruangan berkenaan •
Contoh: Pesakit ibu, tandakan ( ^ )
10. ORANG YANG MENERIMA RAWATAN
1. AHLI SENDIRI
2. SUAMI
3. ISTERI
4 IBU
5 BAPA
6. ANAK
7. ADIK-BERADIK
8. ORANG YANG DILULUSKAN
OLEH LEMBAGA
Nama Orang Menerima Rawatan (Jika bukaa ahli sendiri)
Jika orang yang menerima rawatan adalah ibu tuan/puan, isikan nama ibu tuan/puan di dalam petak-petakyang berkenaan. Jika nama ibu tuan/puan adalah Julia bte Ahmad, tuliskan seperti di bawah :
J
11
u. NAMA
L I
ORANG
A
MENERIMA
B T E
RAWATAN (JIKA
A H M
BUKAN
A D
\HL1 SENDIRI)
12. No. Kad Pengenalan/ Sijlll Kelahiran Orang vang Menerima Rawatan
Islkan No. Kad Pengenalan orang yang menerlma rawatan. Contohnya, jlka No. Kad Pengenalan ibu tuan/puan ialah 450903 - 01 - 2346, tullskan sepertl dl bawah :
12. NO. KAD PENGENALAN/ SIJIL KELAHIRAN ORANG YANG MENERIMA RAWATAN
0 0
13. Alamat Ahli
Tullskan alamat surat menyurat tuan/puan dengan lengkap. Jlka alamat surat menyurat tuan/puan adalahLot 10, Kg Pant Kadlr Tlmur, Buklt Paslr, 84300 Muar, Johor Darul Takzlm, slla penuhl sepertl berlkut •
T
O
I
T
M
POSKOD
8 4 3
NEGER1
J O H
U
0
o
1
R
0
0
R
B
K
U
G
K
BANDAR
M U A
D A. 1 R
I
R
U
13.
P
T
L
ALAMAT AHLI
A R
P
T
I
A
A
T
S
K
I
Z
R
I
A D I R
M
14. Nombor Telefon
Islkan nombor telefon dl ruangan yang dlsedlakan dl bawah :
Contoh : Nombor Telefon Pejabat : 07 - 9859450 dan Nombor Telefon Rumah/Blmbit : 016 - 2070158
14. NOMBOR TELEFON PEJABAT8 0
NOMBOR TELEFON RUMAH/BIMBIT
2 0 7 10 1 5 8
IS. Jenis Pembavaran
Jika t uan /puan memilih kaedah pembayaran kredit ke akaun bank, tanda K ) dl ruang yang berkenaansepertl dl bawah ;
WARAN
DRAF BANK ASING
I S . JENIS PEMBAYARAN
ARAHAN BAYARAN
KREDIT KE AKAUN BANK 1'16. Kod Bank
Isikan nombor kod bank dl ruangan yang disediakan seperti di bawahJlka kod bank tuan/puan adalah Maybank
16. KOD BANK
RHB BankMaybankBumiputra CommercePublic BankHong Leong BankHong Leong FinanceAffin BankEON Bank
010 20 30 40 50 6070 8
Arab Malaysian BankAlliance BankSouthern BankUtama BankBank MuamalatArab Malaysian FinanceBank Islam
0 91011120 31314
17, Nombor Akaun Bank
Jika nombor akaun bank adalah 1-23456 -789012-3, islkan ruangan berkenaan sepertt di bawah :
17. NOMBOR AKAUN BANK
1 3 I 9 | 0 1
18. Jenip Akaun
Jika akaun tuan/puan adalali jenis konvensional, tanda ( /) di ruang yang berkenaan sepcrti di bawah
18. JENIS AKAUN
KONVENSIONAL
AL-WADIAH
19. Nama Hospital/Institusi Perubatan/Kesihatan
Jika tuan/puan/pesakit mendapat rawatan daripada Pusat Pakar Utara Sdn. Bhd., sila tuliskan seperti dibawah :
p
s
u
D
19. NAMA HOSPITAL
S
N
A T
B H
P
D
A
INSTITUSI
K A 1 RPERUBATAN/KESIHATAN
U T A R A 1
20. Alamat Hospital/Institusi Perubatan/Kesihatan
Jika alamat hospital berkenaan adalah No. 21, Jalan 11/2, 40000 Shah Alam, Selangor Darul Ehsan,Tuliskan seperti di bawah :
20. ALAMAT HOSPITAL/INSTITUSI PERUBATAN/KESIHATAN
N 0
POSKOD
4 0 0
2
0
1
0
J A L
• BANDAR
S H A
A
H
N
A
1
L
1
A
/ 2
M
NEGERI
S E L A N G O R D A R U L E H S A N
21 . Jenis Pengeluaran. Nombor Ahli. Npmbor Kad Pengenalan Dan Cap Ibu Jar!
Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanantuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hltam.
NAMA :
NO. AHLI : TEL:(P) (R).
1.0 PERHATIAN
1.1
1.2
1.3
1.4
1.5
1.6
1.7
Sekiranya permohonan diserahkan di kaunter KWSP, sila kemukakan dokumen asal beserta salinannyauntuktujuan pengesahan oleh Pegawai KWSP.
Sekiranya tuan/puan mengemukakan salinan dokumen sahaja, sila pastikan semua salinan dokumen telahdisahkan oleh pegawai yang dibenarkan oleh KWSP seperti berikut lengkap dengan nama dan cop rasmipengesah (kecuali salinan dokumen-dokumen tertentu yang telah ditetapkan PegawaiPengesahnya oleh KWSP):
1.2.1. Pegawai KWSP yang terdiri daripada- Pegawai KWSP Gred 18 keatas- Pegawai Kaunter KWSP
1.2.2. Majikan Pemohon1.2.3. Penghulu atau Penggawa1.2.4. JaksaPendamai
1.2.5. Pengamal Perubatan yang berdaftar1.2.6. Peguambela dan Peguamcara1.2.7. Kumpulan Pengurusan/Profesional Kerajaan1.2.8. Ahh Dewan Undangan Negeri1.2.9. Ahli Parlimen
1.2.10. Pesuruhjaya Sumpah
Sekiranya permohonan bersama, sila sediakan I set dokumen bagi setiap permohonan.
Setiap borang permohonan hendaKlah ditulis dengan pena dakwat berwarna hitam. Tuan/puan hendaklahmenurunkan cap ibu jari kiri dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Jariberwama hitam.
Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-sama dengan borangpermohanan DIKLIPKAN dan tidak menggunakan dawai kokot (staples).
Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4.
KWSP berhak menolak mana-mana permohonan yang tidak lengkap.
2.0 DOKUMEN UTAMA
Tandakan ( V ) dalam kotak yang berkenaan
2.1 Borang Permohonan KWSP 9D (AHL) - 2 salinan | |
2.2 Borang KWSP 3A (AHL) -1 salinan [
2.3 Salinan Kad Pengenalan ahli, ateu I I
Salinan Kad Pengenalan Poiis/Tentera dan Surat Pengesahan Majikan menyatakan | |Nombor Kad Pengenalan Awam dan nombor Polis/Tentera merujuk kepada orangyang sama.
2.4 Salinan muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan slauPenyata Akaun Bank Semasa yang asa! Pemohon hendaklah menurunkan cap ibu jari kiri dankanan di atas salinan tersebut. Sekiranya tuan/puan manghantar melalui pos, salinan dokumenhendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, silakemukakan dokumen asal beserta salinannya bagi tujuan pengesahan oleh Pegawai KaunterKWSP.
2.5 Laporan Perubatan yang tidak melebihi satu tahun yang mengandungi: | [
(a) Butiran Pesakit(b) Keadaan Kesihatan semasa Pesakit(c) Tankh Laporan(d) Nama Pusat Perubatan(e) Nama dan Cop Rasmi Doktor(f) Tandatangan Doktor
(Sekiranya salinan Laporan Perubatan dikemukakan, hendaklah disahkan oleh Doktor/Hospitalberkenaan atau Pegawai KWSP seperti di para 121)
2.6 Surat pengesahan dan maiikan samada kos rawatan dibiayai oleh majikan atau tidak [__
(Sekiranya pesakit adalah anak pengesahan majikan ibu dan bapa diperlukan dan sekiranyapesakit bekerja, surat pengesahan majikan pesakit juga diperlukan Bagi pesakit Dasangan suamiisten, pengesahan majikan pesakit dan pasangan diperlukan)
2 7 Bil dan resit bayaran dan pusat perubatan yang tidak melebihi satu tahun dan tankh permohonan | |(jika bayaran telah dibuat)
ATAU
Anggaran kos rawatan dan pusat perubatan atau pakar bagi rawatan yang dilakukan bagi ahliyang memerlukan surat jaminan KWSP untuk mendapatkan rawatan
(Sekiranya salinan bil/resit bayaran/anggaran kos rawatan dikemukakan, hendaklah disahkanoleh Doktor/Hospital berkenaan atau Pegawai KWSP seperti di para 1.2.1)
2.8 Bukti pertahan di antara ahli dan pesakit. (Jika pemohon bukan pesakit)
Tandatangan Ahli : Tankh
Tandatangan Penenma : Tankh
KUMPULAN WANG SIMPANAN PEKERJA1 OGOS 2001
KWSP9C (AML)PERCUMA
AKTA KUMPULAN WANG SIMPANAN PEKERJA1991PEMBERITAHUAN PENGELUARAN
MEMSEU / MEMBINA RUMAH ATAU MENGURANGKAN / MENYELESAIKAN PINJAMAN
PERHATIAN • MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATA'J TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEMBERIKAN APA-APADOKUMEN PALSU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MELAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BOLEH DIDENDA ATAU DIPENJARA ATAUKEDUA-DUANYA
KEGUNAAN KWSP SAHAJA
KP
HURUF AWALANNAMA AHLI
MOD PEMBAYARAN
WARAN
DRAF BANK ASING
ARAHAN BAYARAN
KREDITKEAKAUNBANK
1
2
3
4
KOD PINJAMAN
AHLI
PASANGAN
JENIS AKAUN
KONVENSIONAL
ALWADIAH
1
2
DISEMAKOLEHPEGAWAI PENYEMAK
CAW UNfT
NOK/TGN
TARIKH
1 JENIS PFNGELUARAN YANG DIPOHON SILA TANDAKAN I -J) PI KOTAK YANG BERKENAAN
1 JENIS PENGaUARAN
1
2
3
MEMBai / MEMBINA RUMAH
MENGURANGKAN / MENYaESAIKAN PINJAMAN
MENGURANGKAN / MENYaESAIKAN PINJAMAN PASANGAN
PERTAMA KEDUA
2 NOMBORAHLI
BUTIRANAHU
3. NOMBOR KAD PENGENALAN 12 DIGIT
4 NO KAD PENGENALAN 70IGIT/POUS/TENTERA/PASPORT/DSB 5 TARIKH SURATPERJANJIAN JUAL BELI 6 KETURUNAN
•7 NAMA MENGIKUT KAD PENGENALAN/PASPORT
1
1
JANTINA
1ELAKI
PEREMPUAN
9 HARGA BaiAN / KOS PEMBINAAN 10 JUMAH PINJAMAN / BAKI PINJAMAN
RINGGIT MALAYSIA SEN RINGGIT MALAYSIA SEN
11 SEKTOR PEKERJAAN 12 BUTIRANHARTA
BEKERJASENDIRI
KERAJAAN
SWASTA
TIDAK BEKERJA
NO LOT/PT
NO HS(M/D)
NO PARCEL
FLAT/APP/
KONDOMINIUM
13 ALAMAT HARTA
|
POSKOO BANDAR
NEGERI
14 ALAMAT AHLI
I T I I IPOSKOD BANDAf
NEGERI
15 NOMBOR TaEFON (PEJABAT)
NOMBOR TaEFON (RUMAH)i
16 JENIS PEMBAYARAN
WARAN
DRAF BANK ASING
ARAHAN BAYARAN
KREDITKEAKAUNBANK
17 KOD BANK
BUTIRAN BANK
18 NOMBOR AKAUN BANK (Hanya untuk membei/membma mmah)
19 JENIS AKAUN
KONVENSIONAL
AL-WADIAH
| I I20 NOMBOR AKAUN PINJAMAN PERUMAHAN
(Hanya untuk mengurang/menyetesakan pin|amanj
| I I
AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991PEMBERITAHUAN PENGELUARAN
50 TAHUN/55 TAHUN/DIVIDEN/KETIDAKUPAYAAN
KWSP98(AHL)PERCUMA
PERHATIAN MANAMAM ORAN& YANG MEMBUAT W APA KENYA MAN U N G TIDAK BETUL \TAU TIDAK BENAP A I A U M NGFMUKAKAN ATAU MEMBERiKAN APAAPA DOKUVLN PAISLJALAM A H A / O A BUTIRBUTIR MUSTAhAK ADALAH MELAKJKAN KfcSALAHAN DAN AKAN MENYE8ABKAN ) RlNYA BOLEH DIDENDA ATAU DIPENJARA ATAU KEDUA DUANYA
KEGUNAAN KWSP SAHAJA
KP
l
KJRLFAWALAN\|AKA AHL
•L"X_"MOD PFMBAYARAN
/VARAN
DRAFBANKASING
\RAHAN BAYARAN
KREDIT KEAKAl IN BANK
__JENISAKAUN
KONVENSIONAL
Al WADIAH
STATUS AKAJNAHU
I Pt.NE.RiVK BAY/"ANt. _ —
AHL!
UISEMAK OLEHPFGAWAI PFNYFMAK
1 AW |
I r\—
NIT
NO KTCN
JZLT:1 \RIKH
DISAHKANOLEHPLGAWAI PENGESAH
NO KTGN
~T~TL_ I
ARKH
DILULoSKAN OLtHPECAWM PELJLUS 1
NO
J.
ARKH
PEGAWAI PELULUS 2
NO K/TGN
L. TARIKH
SILATANOAKAN (V) Dl KOTAKYANGBERKbNAAN
1 JENIS
PtNGELLARAN
50 TAHUN
DI/IDEN
ri5 TAHUN
KE [IDAKUPAYAAN
LNTUK PENGELUARAN 55TAHUNFKIRANYA AHLI MASIH BEKERJA DAN NGIN IfcRUS
\FNCARUM TANDAKAN (V) Dl RUANGAN BERKENAAN1 NblN TERUS MENCARUM YA ( ) "IDAK ( ) JIKA M
bILA ISIKAN BORANG KWSP 20 (AHL) DAN KWSP ?0A AriL)' i iiiTiii/ nc r̂rtCi I IADIU DCUIIU
BUTIRANAHIl
2 NOMBOR AHII
UNTUK PENGELUARAN PENUHADA PEMINDAHAN PELABURAN YA (
1 I OMBOR KAD PENGENALAN 12 DIGIT
TIDAK (
4 NOMBOR KAD PENC EN \LAN 7 DIGIT 5 NOMBfR POMS TENTERA/PASPORT/DSB
nrrnmnzz
6 NAMA MENGIKUT KAD PENGENALAN/PASPARr
nnznznn: nxizn 7 KETURUNAN
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8 TARIKH LAHIR
h B B T T
9 JANTINA
TJ L
10 SEKTOR PEKERJAAN
LEuAKI
PEREMPUAN
11 ALAMATAHU
PJ&KOD
NEGfcRI
BANDAR
12 NOMBOR TELEFON PEJABAT
inu i in iTxrn:13 JENIS PEMBAYARAN
WARAN
NOMBOR TbLEFON RUMAH/BIMBIT
njznjrrN
BANK \SING
ARAHAN BAYARAN
KREDIT KEAKAUN BANK
BUTIRAN AKAUN BANK
14 KOOBANK 11) NC MBOR AKAUN BANK nn16 JENIS_AKAUN
KONVENSIONAL
nL WAOIAt ISAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Di KWSP MENURUT PERUNTUKAN AKTA KWSP 1991
17
JENIS PENIGtLUARAN
NOMBOKAHU1
CAP Bt i R K R ( ANKANANAHLI
(MESTI DITJKUNKAN DtNOANTrRAMGDANPENJH
CAMBUJARIBf-RW RNAH AM)
NOVRO'< Wf
K1SJj '
1ARIKI-
T ""I
LJMNAH
KUMPULAN WANG SIMPANAN PEKERJA
SENARAISEMAKAN SKIM PENGELUARAN PERSARAAN50 TAHUN/55 TAHUN/DIVIDEN
NAMA : ,.
NO.AHL! : , TEL: (P) , (R)
1.0 PERHATIAN
1.1. Sekiranya permohonan diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannyabagi tujuan pengesahan oleh Pegawai KWSP.
1.2. Sekiranya tuan/puan mengemukakan salinan dckumen sahaja, sila pastikan semua salinan telahdisahkan oleh pegawai yang dibenarkan oleh KWSP seperti bcrikut lengkap dengan nama dan coprasmi pengesah : -
1.2.1. Pegawai KWSP yang terdiri daripada 1.2.6. Peguambela dan Peguamcara- Pegawai KWSP Gred 18 keatas 1.2.7. Kumpulan Pengurusan/Profesional
Pegawai Kaunter KWSP Kerajaan1.2.2 Majikan Pemohon 1.2.8. Ahli Dewan Undangan Negeri1.2.3 Penghulu atau Penggawa 1.2.9. Ahli Parlimen1.2.4 Jaksa Pendamai 1.2.10. Pesuruhjaya Sumpah1.2.5 Pengamal Perubatan yang berdaftar
1.3. Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam. Tuan/puanhendaklah menurunkan cap ibu jari kin dar kanan dengan terang dan penuh menggunakan PadCap ibu Jari berwarna hitam.
1.4. Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-sama denganborang permohonan DIKUPKAN dan tidak menggunakan dawai kokot (staples).
1.5. Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4.
1.6. KWSP berhak menolak mana-mana permohonan yang tidak lengkap.
2.0 DOKUMEN UTAMA
Tandakan (V) dalam kotak yang berkenaan.
2.1. Borang permohonan KWSP 9B(AHL) - 2 salinan
2.2. Borang KWSP 3A (AHL) - 1 salinan
2.3. Salinan Kad Pengenalan
Salinan Kad Pengenalan Polis/Tentera danSurat Pengesahan Majikan menyatakan No. Polis/Tentera danNo. Kad Pengenalan merujuk kepada orang yang sama
2 4 Salinan pasport bagi warganegara aslng(Sila kemukakan salinan pasport yang lama sekiranya nombor pasport terkiniberbeza dengan rekod KWSP)
2 5 Salinan muka hadapan Buku Akaun Bank yang mengandungi butir-butir akauntuan/puan atau Penyata Akaun Bank Semasa yang asal. Pemohon hendaklahmenurunkan cap ibu jari kin dan kanan di atas salinan tersebut. Sekiranya tuan/puanmenghantar melalui pos, salinan dokumen hendaklah disahkan oleh Pegawai Bankberkenaan dan sekiranya diserahkan di kaunter, sila kemukakan dokumen asal besertasalinannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSP
3.0 DQKUMEN TAMBAHAN
3 1 Sijil Kerakyatan/Syil Kelahiran (jika No Kad Pengenalan tiada dalam rekod KWSP)
Tandatangan Ahli Tarikh
Tandatangan Penerima : Tarikh
KUMPULAN WANG SIMPANAN PEKER.JA1 OGOS 2001
AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991PEMBERITAHUAN PENGELUARAN
50 TAHUN/55 TAHUN/DIVIDEN/KETIDAKUPAYAAN
KWSP 9B (AHL)PERCUMA
PERHATIAN : MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATAU TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEMBERIKAN APA-APA DOKUMEN PAl.SUDALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MF.LAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BO1.EH DIDENDA ATAU DIPENJARA ATAU KEDUA-DUANYA
KEGUNAAN KWSP SAHAJA
i KREDIT KE AKAUN BANK
JENISAKAUN
KONVENSIONAL
AL-WADIAH
1
2
STATUS AKAUN AHLI
AKTIF
TUTUP
(UNTUK PENGELUARAN D2-5)
PENERIMA BAYARAN
AHLI
PENJAGA
(UNTUK PENGELUARAN D2-6)
OISEHAKOLEH :Pf.GAWAIPENYEMAK
SILATANDAKAN (V) Dl KOTAK YANG BERKENAAN
1. JEMS
PENGELUARAN
1
3
50 TAHUN
DIVIDEN
2 | 55TAHUN
4 I KETIDAKUPAYAAN I
BUTIRAN AHLI
UNTUKPENGELUARAN55TAHUN: jSEKIRANYA AHLI MASIH BEKERJA DAN INGIN TERUS |MENCARUM, TANDAKAN (V) Dl RUANGAN BERKENAANINGIN TERUS MENCARUM YA ( ) TIDAK { j . JIKAYA,SILA ISiKAN BORANG KWSP 20 {AHL) DAN KWSP 20A [AHL) iUNTUK PENGELUARAN PENUH : |ADAPEMINDAHAN PELABURAN. YA( } TIDAK', ) I
2. NOMBOR AHLI
J4. NOMBOR KAD PENGENALAN 7 DIGIT
_ _ I
L J L3. NOMBOR KAD PENGENALAN 12 DIGIT
r r r EEUD5. NOMBOR POUS/TENTERA/PASPORT/DSB
6. NAMA MENGIKUT KAD PENGENALAN/PASPORT
imnmu-immrnmcmnmujjjjjjjmnmni]
8. TARIKri LAHIR 9. JANTINA 10. SEKTOR PEKERJAAN
7. KETURUNAN
•H H B 8 T T LELAKI
PEREMPUAN
•mm:11. ALAMATAHLI
BEKERJA SENDIRI
KERAJAAN
SWASTA
TIDAK BEKERJA
rm ~ Tmir rHi.. TUT i—|—
CAW UNIT
NO. K/TGN
IIL:TARIKH :...
OISAHKANOLEH :PEGAWAIPENGESAH
POSKOD
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n
BANDAR
in
12. NOMBOR TELEFON PEJABAT
D"713. JENIS PEMBAYARAN
NOMBOR FELEFON RUMAH/BIMBIT
I Z L T T T E E I T T ]
WARAN
ORAF BANK ASING
ARAHAN BAYARAN
KREDIT KE AKAUN BANK
BUTIRAN AKAUN BANK
TARIKH
DILULUSKAN OLEH :PEGAWAI PELULUS1
TARIKH
PEGAWAI PELULUS 2
I NO. K/TGN !
LIITTIIIJTARIKH :
14. KOD BANK16. JENISAKAUN
•i5. NOMBOR AKAUN BANK
XD nmmm KONVENSIONAL
AL-WADIAH
SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991.17.
JENIS PENGELUARAN
NOMBOR AHLI
CAP IBU JARI KIRI DANKANAN AHLI
(MESTI DITURUNKAN DENGANTERANG DAN PENUHMENGGUNAKANPAD
CAP IBU JARI BERWARNAHITAM)
TARIKH :
NOMBOR K/P nKIRI KANAN
PANDUAN UNTUK MENGIS! BORANG KWSP 9B (AHL)
PEMBERITAHUAN PENGELUARAN 50 TAHUN / 55 TAHUN / DIVIDEN / KETIDAKUPAYAAN
SILA BACA PANDUAN INI DENGAN TELITI SFBELUM MENGISI BORANG. BORANG PERMQHQNAN MESTILAH DIPENUHKAN DENGAN HURUFBESAR.
1. Jenis Pengeluaran
Siia tanda (V) dalam petak yang berkenaan Jika tuan/puan memohon pengeluaran 50 Tahun, tandakan (V) seperti di bawah •
. 1. JENISPENGELUARAN
i_3_±
50 TAHUN
DIVIDEN
55 TAHUN
KETIDAKUPAYAAN
Untuk Pengeluaran 55 Tahun
Sekiranya ahli masih bekerja dan mgin terus mencaoim, sila tandakan (V) di ruangan yang berkenaan.
INGIN TERUS MENCARUM ( V) YA ( ) TIDAK
Untuk Pengeluaran Penuh
ADA PEMlNDAHAN PELABURAN, YA ( V ) TIDAK ( )
Nombpr Ahli
Isikan satu digit di setiao ruang dengan didahului oleh digit '0' jika perlu, seperti contoh di bawah:
Contoh : 1234567
2. NOMBORAHLI
0 1 2
3. Nombor Kad Pengenalan 12 Digit Ahli
Isikan nombor Kad Pengenalan 12 digit tuan/puan Jika tuan/puan belum memiliki Kad Pengenalan 12 digit, kosongkan ruanganini :
Contoh : 460701-02-6157
3. NOMBOR KAD PENGENALAN 12 DIGIT
I0 1 0 JNombor Kad Pengenalan 7 Digit
Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah
4. NOMBOR KAD PENGENALAN 7 DIGIT
a)
b)
1234567
A 1234567
2
L73
» .LL 5 g—̂
7
c) K1234567
d) H1234567 6
5. Nombor Polis/Tentera/Pasport/Dsb
Isikan Nombor Polis/Tentera/Pasport/Dsb, seperti contoh di bawah :
5. NOMLOR POLISffENTERA/PASPORT/DSB
a) I 1234567 ' 1
b) T 1234567 1 2 3 5
Nama Mengikut Kad Pengenalan/Pasport
Tuliskan nama tuan/puan sebagaimana yang tercatat dalam kad pengenalan. Jika nama mengikut kad pengenalan ialah Norman
bin Abdullah, sila tuliskan nama seperti di bawah;
N 0 R6.M
NAMA MENGIKUT KAD PENGENALAN/PASPORT
A N B JJ N
i
A B D U L L A H
Keturunan
Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, isikan seperti di bawah:
7. KETURUNAN
MelayuCinaIndiaLain-lain
1
1234
BidayuhKadazanIban
Tarikh Lahir
Isikan tarikh lahir tuan/puan mengikut susunan hari, bulan dan tahun. Jika tarikh lahii tuan/puan pada 1 Julai 1946, isikan seperti dibawah:
8. TARIKH LAHIR
H
0
H
1
B
0
B
7
T
4
T
6
Jantina
Tandakan jantina tuan/puan dengan (S) dalam ruang yang disediakan. Jika lelaki, tandakan (V) di ruang yang berkenaan sepertidi bawah:
9. JANTINA
LELAKI
PEREMPUAN
10. Sektor Pekeriaan
Tandakan (</) dalam ruang yang disediakan. Jika tuan/puan bekerja dalam sektor swasta, tanda (S) dalam ruang yang berkenaan
seperti di bawah:
10. SEKTOR PEKERJAAN
BEKERJA SENDIRI
KERAJAAN
SWASTA
TIDAK BEKERJA
11. Alamat AhliTuliskan alamat surat menyurat tuan/puan dengan lengkap. Jika alamat surat menyurat tuan/puan adalah Lot 10, Kg Parrt KadirTimur Bukit Pasir, 84300 Muar, Johor Darul Takzim, sila penuhi seperti berikut:
12.
13.
L
| T
O T
I
POSKOD
I ' 4
NEGERI
I ' 0
M
3
H
Nombor Telefon
1 "of TKI I
G
U
0
O
R I ] B I U
BANDAR
0
R
K
A
R
1
R
U
11. ALAMAT AHLI
A R
P
T
I
A
A
1
s 1
K 1
K
»
A D 1 R
1
M
Isikan nombor telefon di ruangan yang disediakan di bawah.
Contoh : Nombor Telefon Pejabat: 07-9859450 dan Nombor Telefon Rumah/Bi.-nbit 016-2070158
12. NOMBOR TELEFON PEJABAT
7 9 8 sT7T4 5•
NOMBOR TtLEFON RUMAH/BiWBIT
lil 1 6
Jenis Pembavaran
?J 0 |7 [0 1 5 | .
Jika tuan/puan memilih cara pembayaran kredit ke akaun bank, tanda (S) di ruang yang berkenaan seperti di bawah .
13. JENIS PEMBAYARAN
WARAN
DRAFBANKASINGi LARAHAN BAYARAN
I KREDIT KE AKAUN BANK
14. KodJank
isikan nombor kod bank di ruangan yang disediakan seperti di bawahJika kod bank tuan/puan adalah Maybank
14. KOD BANK
rzRHB BankMaybankBumiputra CommercePublic BankHong Leong BankHong Leong FinanceAffin BankEON Bank
0102030405060708
Arab Malaysian BankAlliance BankSouthern BankUtama BankBank MuamalatArab Malaysian FinanceBank Islam
09101112131415
15. Nombor Akaun Bank
Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah
15. NOMBOR AKAUN BANK
1 2 3 4 5 6 7 8 9 0 1 2 3
16. Jenis Akaqn
Jika akaun tuan/puan adalah jenis konvpnsional, tanda (*Q di ruang yang berkenaan seperti di bawah
16. JENIS AKAUNKONVENSIONAL
AL-WADIAH
•
17. Jenis Pengeluaran, Nombor Ahli. Nombor Kad Pengenalan dan Cap Ibu Jari
Isikan jenis pengeluaran, nombor ahl' dan nombor kad pengenalan serta turunkan cap ibu jari kin dan kanan tuan/puandengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam
KUMPULAN WANG SIMPANAN PEKERJAEMPLOYEES PROVIDENT FUND
SENARAI SEMAKAN SKIM PENGELUARAN MENINGGALKAN NEGARALEAVING COUNTRY WITHDRAWAL CHECKLIST
Nama AhliMember's Name
No Ahli Tel (P) (R)Member's No Tel(O) (R)
No PasportPassport No
10 PENTINGIMPORTANT
1 1 Sekiranya permohonan diserahkan di kaunter KWSP sila kemukakan clokumen asal beserta salmannya untuk
tujuan pengesahan oleh Pegawai KWSPWhen submitting the application form at the counter please produce ongmal documen's together with the photostate copies of the documentfor the purpose of certification by EPF officers
" ? bekiranya tuan/puan mengemukakan salinan dokumen sahaja sila pastikan semua saiman dokumen telah disahkan oiehmajikan tuan/puan dtau pegawai yang dibenarkan oleh KWSP seperti benkul lengkap dengan nama da i cop rasmipengesah -When submitting photostate documents please ensure that photostate copies of all the documents are certified true copy by vcur e 7)o/o> er orauthorized officers as follows complete with the name and official stamp of the officer concerned
1 21 Pegawai KWSP -EPF Officer
Pegawai KWSP (Gred 18 ke ata«)EPF Officer (Grade 18 and Above) '
Pegawai Kaunter KWSPEPF Counter Officer
1 2 2 Pegawai Kedutaan MalaysiaMalaysian Embassy Officer
' 2 3 Notan AwamPublic Notary
1 3 Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwdrna hjldDl Tuan/puan hendaklah menurunkan capbu jan kin dan xanan de^iqan terang dan penuh menggunakan Pad Cap Ibu Jan bciyvarna hjtam.Ldch withdrawal form must be completed using bjsoi ink pa Members must a/so affix higher nght and left thumbpnnt cleiriy and in lullusing black ink thumbpnnt psd
14 Tuan/puan henolakldh rr^mastikdn dokumen dokunen yang disertakan beibama sama dengan borang oermohonanDIKLIPKAN dan tidak menggunakan dawai kokot (staples)Please ensure that all documents forwarded togethei with the apulicatior form are CLIPPER md not stappled
1 5 Semua salinan fotostat dokumen hendaklah me iggunakin kertas saiz A4All photostate cop'es of documents must be on A4 sue pap°r
1 6 KWSP berhak menolak mana manu permohoPcn yang •idak lengkapEPF reserves the ngh1 to 'eject incomplete application
2 0 DOKUMEN UTAMA
MAIN DOCUMENTS
Tandakan (V) dalam kotak yang berkenaanPlease tick (V) in the box where applicable
2 1 Borang Permohonan KWSP 9B (AHL) - 2 salinan
2 2 Borang KWSP 3A (AHL) - 1 salinanForm KWSP 3A (AHL.) -1 copy
2 3 Salman muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan atauPenyata Akaun Bank Semasa yang asal Pemohon hendaklah menurunkan cap ibu jan kin dankanan di atas salinan tersebut Sekiranya tuan/puan menghantar melalui pos, salinan dokumenhendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, silakemukakan dokumen asal beserta sahnannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSPPhotostate copy of the front page of your bank book with details of your bank account number ox the originalcopy of your current Account Bank Statement Applicants are required to affix left and right thumb print impressionon copies of the document Please forward the ongmal document together with a photostate copy to be certifiedby the EPF Counter Officers at the counter Photostate copy of the bank book mus< be cenified true copy by therespective bank's officer if submission ii through post
3.0 PEGAWAI DAGANGEXPATRIATE
3 1 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport(Sila serahkan salinan pasport yang lama sekiranya nombor pasport terkini berbeza denqan rekod KWSP)Photostate copy of valid passport stating clearly your name and passport number(Please forward photostate copy of old passport if current passport number differs from EPF records)
3 2 Bukti penamatan kerjaProof of resignation/tenmnption of contract
- Surat penamatan kontrak oleh majikanAcceptance of resignation/termination of contract by employer
ATAUOR
- Penyata Perlepasan Cukai PendapatanIncome tax clearance lefer
3 3 Pembatalan permit kerja (Tidak malebihi 3 bulan dan tankh permohonan)Cancellation of work permit(Not exceeding 3 months from the date of application)
3 4 Sila bekalkan alamat ahli di luar negaraPlease give your overseas correspondence address
4.0 BEKAS WARGANEGARA MALAYSIArAYSIAN CITIZEN
4 1 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasportPhotostate copy of valid passport stating clearly your name and passport number
4 2 Surat Penyerahan Kad Pengenalan dan Pelucutan Kewarganegaraan danpada Pejabat Pendaftaran NegaraLetter of surrendenng of the Identity Card and renounciation of citizenship from the Registration Office
4 3 Sila bekalkan alamat ahli di luar negaraPlease give your overseas correspondence address
50 PEKERJA ASINGFOREIGN WORKER
51 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport
(Sila kemukakan salinan pasport yang lama sekiranya nombor pasport terkini berbeza dengan rekod KWSP)Photostate copy of valid passport stating clearly your name and passport number(Please forward photostate copy of old passport if current passport number differs from EPF recoros)
5 2 Sila bekalkan alamat ahli di luai negaraPlease give your overseas correspondence address
60 DOKUMENTAMBAHANADDITIONAL DOCUMENT
61 SIJII Perkahwinan(Sekiranya nama di dalam pasport berlainan dengan rekod KWSP)Marriage Certificate(If name in the passport aiffers from EPF records)
Tandatangan Ahli TankhVeinbf" > Signature Date
Tandatangan Penenma TankhRf teiver s Signature Date
KUMPULAN WANG SIMPANAN PEKERJA1 O&OS 2001
AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991PEMBERITAHUAN PENGELUARAN
MENINGGALKAN NEGARA
KWSP 96 (AHL)PERCUMA
PERHATIAN • MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK B E T U L ATAU TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEM6ERIKAN APA-APAIOKUMEN PALSU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MELAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BOLEH DIDENOA ATAU DIPENJARA ATAU£DUA-DUANYA
ATTENTION ANY PERSON WHO MAKES ANY UNTRUE OR FALSE STATEMEN1S OR PRODUCES ANY FALSE DOCUMENTS REGARDING ANY MATERIAL PARTICUtARS IS COMMITTING AN OFFENCE ANO IF FOimO GUL TYSHALL BF LIABLE TO 'MPRISONMENT OR FINE OR BOTH
KEGUNAAN KWSP SAHAJAFOR EPF USE ONLY
KPDC
nxo
MOD PEMBAYARAN
MODE OF PAYMEN1
WARANWARRANT
ORAFBANKAS'NGFORE'GN BANK DRAFT
APAHAN BAYARAN] tW'KWlFSS
P K R F D I T K E AKAUN BANKDIRECCREDITING
j c M b AKAUNYPE OF ACCOUN1
KONVtNSIONAI CONVENTIONAL
[ ALWADIAHL ALWADIAH
DISEMAK OLEHPEGAWAI PENYEMAK
CHECKED BY OFFICER IN CHARGE
IAWKHOATt
BUTIRANAHLIPARTICUIARS OF MEMBER
1 NOMBORAHUMtMBERS NUMBER
J2 NOMBOR KAD PENGENALAN 12 DIGIT
<1 DIGIT IDENTITY CARD NUMBER
OUT3. NOMBOR KAD PENGENALAN 7 DIGIT7 DIGI1 IDENTITY CARD NUMBER
4 NOMBOR POLIS/TENTERA/PASPORT/DSBPOLICEMUTARY/PASSPORTNUMBER/ETCnxxxixx
5 NAMA MENGIKUT KAD PENGENALAN/PASPORTNl^MF AS PER THE APPLICANTS IDENTITY CARD/PASSPORT
6 KETURUNANRACE
n
7 TARIKHL/HIRDATEOF8IR~H
TV
I J\N1INAGENDER
9 SEKTOR PEKERJAANEMPLOYMENT SECTOR
H0
HD
BM
8M
LELAKIMALE
PEREMPUANFEMALE
BCKERJASENDIRii f ( . f EMPLOYED
KERAJAANGOVERNMENT
SWASTAPRIVATE
TIDAK BEKERJAUNEMPLOYED
10 ALAMATArlUMEMBER S ADDRESS
POSKODPOSTCODE
BANDARCITY
NEGERISTATE
nzninzinin "i_ nzn :n _ m11 NOMBOR TEL EF ON PEJABAT
OFHCt IELEPHO'IE NUMBER
12 JENIS PEMBAYARANDPC OF PAYMENTrrxx
NOMBOR IFLEFON RUMAH
'ESIDlNCEJTLEPHONEI UMBER/HANWHONE
J L J
vVARANWARRANT
DRAFBANKASINCFOREIGN BANK DRAF i
ARAHAN BAYARANWARRANTLESS
KREDIT KE AKAUN BANKDIRECT CREDITING
BUTIRAN AKAUN BANKPAPTICULARS OFBANKACK-OUNI
13 KODBANKBANK CODE
14 NOMBOR AKAUN BANKBANKAt^OLNlNbMbER
xixixxLxn15 JENbAKALNTYPE OF ACCOUM
KONVENSIONALCONVENTIONALAL WADIAHAL WADIAH
PEMBERITAHUAN :OISAHKAN OLEH:
PEGAWAI PENGESAHNOTIFICATIONVERIFIED BY
OFFICER IN-CHARGE
NO K/TGNSTAFF REF NO
TARIKHDATE
DILULUSKAN OLEH :PEGAWAI PELULUS 1
APPROVED ByAPPROVAL OFFICER 1
NO K/TGNSTAFF REF NO
TARIKHDATE
PEGAWAI PELULUS 2APPROVAL OFFICER 1
NO K/TGNSTAFF REF NO
TARIKHDATS
SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991./ HEREBY APPLY TO WITHDRAW VY EPF CREDIT IN ACCORDANCE WITH THE EPF ACT 13S1
16.
JENISPENGELUARAN
TYPE OFWITHDRAWAL
NOMBORAHLIMEMBER'S NUMBER
T
CAP IBU JARI KIR! DANKANAN AHLI
(MESTI DITURUNKAN DENGANTERANG DAN PENUHMENGGUNAKAN PAD
CAP IBU JARI BERWARNAHITAM1
LEFT AND RIGHT THUMB IMPRESSIONOF THE MEMBER
(MUST BE CLEARLY AND FULL YAFFIXED USING BLACK INK
THUMBPRINT PAD)
TARIKHDATE
I H H NOMBOR K/PH § IDENTITY CARDj g j j j NUMBER
KlfilLEEI
mmBlSiU
17. AKUAN SAKSIWITNESS DECIMATION
"SAYA DENGAN INI MENGAKU DAN MENGESAHKAN BAHAWA BUTIR-BUTIR PEMOHON TERCATAT Dl ATAS ADALAH MENGIKUT KADPENGENALAN MALAYSIA / SINGAPURA / POLIS / TENTERA / PASPORT YANG SAVA TELAH PERIKSA SENDIRI DAN PEMOHON TELAHMENURUNKAN CAP IBU JARI KIRI DAN KANANNYA Dl HADAPAN SAYA"
POLICE I MILITARY IDENTITY CARD I PASSPORT THAT I HAVE PERSONALLY EXAMINED AND THAT HE I SHE HAS DULY AFFIXED HIS I HER LEFT AND RIGHTTHUMB IMPRESSION BEFORE ME '
NAMA PENUH SAKSIFULL NAME OP WITNESS
NO KAD PENGENALAN SAKSIIDENTITY CARD NO OF WITNESS
ALAMAT SAKSIADDRESS OF WITNESS
TANDATANGAN SAKSISIGNATURE Of WITNESS
JAWATAN DAN COP RASMIDESIGNATION AND OFFICIAL STAMP
TARIKHDATE
NOTA ;ttSSE
BERIKUT ADALAH SENARAI ORANG YANG BOLEH MENJADI SAKSITHE FOLLOWING PERSONS MAY ACT AS A WITNESS
1 PEGAWAI KWSP YANG TERDIRI DARIPADAEPF OFFICER
PEGAWAI KWSP GRED 18 KE ATASEPF OFFICER GRADE (8 AND ABOVE
PEGAWAI KAUNTER KWSPEPF COUNTER OFFICER
2 MAJIKAN PEMOHONAPPLICANTS EMPLOYER
3 PEGAWAI KEDUTAAN MALAYSIAMALAYSIAN EMBASSY OFFICER
i NOTARIAWAMPUBLIC NOTARY
PANDUAN UNTUK MENGISI BORANG KWSP 9B (AHL)PEMBERITAHUAN PENGELUARAN MENINGGALKAN NEGARA
GUIDELINES TO COMPLETE FORM KWSP 9B(AHL)LEAVING COUNTRY WITHDRAWAL
SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAH DIPENUHIDENGAN HURUF BESAR.PLEASE READ THESE GUIDELINES CAREFULLY BEFORE COMPLETING THE FORM. THE FORM MUST BE COMPLETED IN BLOCK LETTERS.
1 Nombor AhliMember Number
Isikan satu digit di setiap ruang dengan di dahului oleh digit '0' jika perlu, seperti contoh di bawahFill in the space with one number, starting with '0' as shown belowContoh . 1234567Example 1234567
1. NOMBOR AHLIMEMBER'S NUMBER
0
Nombo
1
Kad
2 3 4
Penaenalan 1212-Diait Identitv Card Number
5
Diqit
6 7
Isikan nombor Kad Pengenaian 12 digit tuan/puan Jika tuan/puan belum memiliki Kad Pengenalan 12 digit, kosongkanruangan miFill in your 12-digit Identity Card number Leave this space blank if you do not have any
Contoh 610701-02-6157Example 610701-02-6157
2. NOMBOR KAD PENGENALAN 12 DIGIT12 DIGIT IDENTITY CARD NUMBER
6 1 0 7 0 1 0 2 6 1 5
Nombor Kad Pengenalan 7 Digit / Polis/ Tentera/ Pasport / Dsb7-Digit Identity Card / Police/ Military/ Passport Number/ Etc
Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawahFill m /our 7-digit Identity Card number,mcluding the initial as shown below
a) 1234567
h) A1234567
c) K1234567
d) H1234567
3. NOMBOR KAD ^ENGENALAN 7 DIGIT7 DIGIT IDENTITY CARD NUMBER
4. Nombor Polis/Tentera/Pasport/DsbPolice/Military/Passport Number/Etc
Isikan Nombor Polis/Tentera/Pasport/Etc termasuk huruf awalan, seperti contoh di bawahFill in your police/military'/passport number/etc, including the mtial as shown below
4. NOMBOR POLISH TNTERA/PASPORT/DSBPOLICE/MILITARY/PASSPORT NUMBER/ETC
a) I 1234567
b) T 1234567
Nama Mengikut KadName As Registered In Identity Card I Passport
Tuliskan nama tuan/puan sebagaiinana yang tercatat dalam kad pengenalan tuan/puan Jika nama mengikut kad penqenalanlalah Norman bin Abdullah sha tuliskan nama seperti di bawahWrite your name as registered in your identity card If your name as per your identity card is Norman bin Abdullah, pleasecomplete your name as follows
i r
!
M
HA
5
N
NAMA MENGIKUT KAD PENGENALAN / PASPORTNAME AS PER IDENTITY CARD / PASSPORT
B•
N A B D U L L A H
Keturunan
Isikan ruang dengan mengikut kod keturunan di bawah mi Jika tuan/puan berketurunan Melayu, isikan seperti di bawah
Please complete this portion with rpference to the following For instance ifyou are a Malay
6. KETURUNANRACE
Melayu
Malay
CinaChinese
IndiaIndian
Lam-lam
Others
Tarikh LahirDate of Birth
1
2
3
4
BidayuhBidayuh
Kadazan
Kadazan
IbanIban
Isikan tankh lahir tuan/puan mengikut susunan han, bulan dan tahun Jika tankh lahir tuan/puan pada 1 Julai 1961, isikan seperti di bawahFill in your date of birth according to the date, month and year If your date of birth is 1« July 1361, please fill in as follows
7 TARIKH LAHIRDATE OF BIRTH
H
D
0
H
D
1
B
M
0
B
M
7
T
Y
6
T
Y
1
Jantinagender
Tandakan jantina tuan/puan dengan [•/) dalam ruang yang disediakan Jika lelaki, tandakan {•/) di ruang yang berkenaan
seperti di bawah
Please tick{S) whichever is applicable Ifyou are a male, please fill in as follows
8. JANTINAGENDER
LELAKIMALE
PEREM°UANFEMALE
9. Sektor Pekerjaan AhliEmployment Sector
Tandakan {/) dalam ruang yang disediakan JiKa tuan/puan bekerja dalam seklor swasta, tanda (V) dalam ruang yangberkenaan seperti di bawahPlease tick {/) whichever is applicable If you are working in the pnvate sector, please fill in as follows
9. SEKTOR PEKERJAANEMPLOYMENT SECTOR
BEKERJA SENDIRISELF EMPLOYEDKERAJAANGOVERNMENT
SWASTAPRIVATETIDAK BEKERJAUNEMPLOYED
•
10. AlamatAhliMember's Address
Tuliskan aiamat surat menyyat tuan/puan dengan lengkap Jika alamat surat menyurat tuan/puan adalah Lot 10, Kg PantKadir rmiur, Bukit Pasir, 84300 Muar, Johor Darul Takzim, sila penuhi seperti DerikutPlease complete yow full address If your address is Lot 10, Kg Pant Kadir Timur, Bukit Pasir, 84300 Muar, Johor Darul Takzimplease fill in as follows
II
10. ALAMAT AHLIMEMBER'S ADDRESS
P A R I T
M|U [ R iS I U K I [ M [ P IA | S 1I I I I I L I I I I I i i __i L _J
POSKODPOSTCODE
NEGERISTATE
[7
BANDARCITY
O I R
i
Z I M
11. Nombor Telefon AhliMember's Telephone Number
Isikan nombor telefon di ruangan yang disediakan di bawahContoh Nombor Telefon Pejabat 07 • 9859450 dan Nombor Telefon Rumah/Bimbit 016-2070158Please complete your telephone number (if any) as followsFor example Office Telephone Number 07 • 9859450 and Residence Telephone Number I Handphone 016 - 2070158
11. NOMBOR TELEFON PEJABATOFFICE TELEPHONE NUMBER
NO TELEFON RUMAH/BIMBITRESIDENCE TELEPHONE NUMBER /HANDPHONE
2 0
12. Jenis PembayaranType Of Payment
Jika tuan/puan memilih kaedah pembayaran kredit ke akaun bank, tanda ( / ) di ruang yang berkenaan seperti di bawah :If you choose direct crediting, pleas$ tick ( • ) as below:
12. JENIS PEMBAYARANTYPE OF PAYMENT
WARANWARRANT
DRAFBANKASINGFOREIGN BANKDRAFT
ARAHAN BAYARANWARRANTLESSKREDIT KE AKAUNBANKDIRECT CREDITING
• /
0 2
13. KalBankBqnl{ Code
Isikan nombor kod bank di ruangan yang disediakan seperti di bawah :
Please fill in the bank code number in the space below:
13. KOD BANKBANK CODE
Kod
Code
0102030405060708
Nama BankName of Bank
RHB Bank
Maybank
Bumiputra CommercePublic BankHong Leong BankHong Leong FinanceAffin BankEON Bank
Nama Bank
Name of Bank
Arab Malaysian Bank
Alliance BankSouthern Bank
Utama BankBank Muamalat
Arab Malaysian FinanceBank Islam
KodCode
09101112131415
14. Nombor Akaun BankBank Account's Number
Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah:
If your bank account's number is 1-23456-789012-3, please fill in as below:
15.
1 2 3 4 5 6 7 8 9 0 1 2 3
Jenis AkaunType of Account
Jika akaun tuan/puan adalah jenis konvensional, tanda (V) di ruang yang berkenaan seperti di bawah:
Please tick (</) as below, if your type of account is conventional:
KONVENSIONALCONVENTIONAL
AL-WADIAHAL-WADIAH
•
16. Jenis Pengeluaran, Nombor Ahli, Nombor Kad Pengenalan dan Cap Ibu JariType of Withdrawal. Membership Number. Identity Card Number and Thumb Impression
Isikan jenis pengeluaran, nombor ahli dan nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan tuan/puan dengan
terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.
Kindly fill in type of withdrawal, membership number, identity card number and left and right thumb impression. The impression
must be clear and fully affixed using black ink thumbprint pad.
17. Afcuan SakalWitness Declaration
Senarai orang yang boleh menjadi saksi adalah seperti berikut:The following persons may act as a Witness:
1. PegawaiKWSPterdiridaripada: 3. Pegawai Kedutaan MalaysiaEPF Officer Malaysian Embassy Officer
• Pegawai KWSP Gred 18 Ke atasEPF Officer Grade 18 and above
- Pegawai Kaunter KWSPEPF Counter Officer
2. Majikan Pemohon 4. Notari AwamApplicant's Employer Public Notary