Borang Permohonan Pembaharuan Bagi Perakuan Penangguhan
Borang Permohonan Pembaharuan Bagi Perakuan Penangguhan
Borang Permohonan Pembaharuan Bagi Perakuan Penangguhan
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<strong>Borang</strong> 2 (Form 2)<br />
JLKN /P/:02/Pin 2/10<br />
AKTA LATIHAN KHIDMAT NEGARA 2003<br />
(NATIONAL SERVICE TRAINING ACT 2003)<br />
PERATURAN-PERATURAN LATIHAN KHIDMAT NEGARA (PENANGGUHAN TANGGUNGAN) 2004<br />
(NATIONAL SERVICE TRAINING (POSTPONEMENT OF LIABILITY) REGULATIONS 2004)<br />
PERMOHONAN BAGI PEMBAHARUAN PERAKUAN PEMBAHARUAN PENANGGUHAN<br />
(Peraturan 4)<br />
(APPLICATION FOR RENEWAL OF POSTPONEMENT CERTIFICATE)<br />
(Regulation 4)<br />
*(Sila baca arahan di muka surat 5 dan 6 sebelum mengisi borang ini)<br />
(Please read the instructions on page 5 and 6 before filling up this form)<br />
1. Nama (Name):<br />
2. No kad pengenalan (NRIC number):<br />
Kegunaan rasmi (Official use)—<br />
Diterima oleh (Received by) :.......................................................................................................<br />
Tarikh diterima (Date received) :.......................................................................................................<br />
Siri (Series) :............../....................<br />
Kumpulan (Group) : 1 2 3<br />
Kod (Code) : 1 2 3<br />
Keputusan (Decision)<br />
: Lulus (Approved) / Tidak Lulus (Not Approved)<br />
.............................................. .............................<br />
Ketua Pengarah (Director General)<br />
Tarikh (Date)<br />
/bagi pihak Ketua Pengarah<br />
(on behalf of Director General)<br />
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3. Butir-butir peribadi (Personal Particulars)<br />
a) Alamat tetap (Permanent address):<br />
Poskod (Postcode):<br />
Bandar (City):<br />
Negeri (State):<br />
b) Alamat surat-menyurat [Jika berbeza daripada di atas] (Postal address [If different from above]):<br />
Poskod (Postcode):<br />
Bandar (City):<br />
Negeri (State):<br />
c) Nombor telefon (Telephone numbers):<br />
Rumah (House):<br />
Bimbit (Handphone):<br />
Lain-lain (Others):<br />
d) Alamat e-mel (E-mail address): ………………………………………………………………………….<br />
4. Butir-butir tentang Program Latihan Khidmat Negara (Particulars relating to National Service Training)<br />
a) Nombor rujukan dan tarikh surat pemberitahuan (Reference number and date of notification<br />
letter):<br />
No. Rujukan (Reference No.): .....................................................................................................<br />
Tarikh (Date): Hari Bulan Tahun<br />
(Date) (Month) (Year)<br />
b) Tarikh melapor diri untuk latihan: (Date to report for training)<br />
Tarikh (Date): Hari Bulan Tahun<br />
(Date) (Month) (Year)<br />
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c) Nama kem untuk latihan (Camp allocated for training):<br />
..................................................................................................................................................<br />
5. Butir-butir sebab memohon pembaharuan penangguhan. Sila tandakan ( X ) di mana berkenaan dan<br />
kepilkan bersama dokumen sokongan yang berkaitan. (Particulars on the reason that cause for<br />
postponement renewal. Please mark ( X ) where appropriate and attach all relevant supporting<br />
documents.)<br />
a) Akan menduduki peperiksaan utama (Will be sitting for a major examination)<br />
Masih berada di Tingkatan Lima dan akan mengambil peperiksaan SPM pada tahun ini.<br />
(Currently studying in Form Five and will be sitting for SPM examination this year.)<br />
Berada di Tingkatan Enam Bawah/Atas dan akan mengambil peperiksaan STPM pada tahun<br />
ini/ tahun hadapan.<br />
(Currently studying In Form Lower 6/Upper 6 and will be sitting for STPM examination this<br />
year/ next year.)<br />
Lain-lain. (Sila nyatakan) : ……………………………………………………………………………..<br />
Others. (Please specify) : .........................................................................................................<br />
b) Sedang meneruskan pengajian (Currently pursuing studies)<br />
Sedang meneruskan pengajian di mana-mana institusi pengajian tinggi IPTA / IPTS<br />
(Pursuing studies in any higher educational institutions)<br />
Tarikh mula belajar : Hari Bulan Tahun<br />
(Date of commence) : (Date) (Month) (Year)<br />
Tarikh dijangka tamat belajar : Hari Bulan Tahun<br />
(Expected date of completion) : (Date) (Month) (Year)<br />
Lain-lain. (Sila nyatakan) : ……………………………………………………………………………..<br />
Others, (Please specify) : .........................................................................................................<br />
c) Keadaan yang akan menimbulkan kesusahan luar biasa (Circumstances that will give rise to<br />
exceptional hardships)<br />
Sedang hamil (Currently pregnant)<br />
Tarikh dijangka bersalin : Hari Bulan Tahun<br />
(Expected date of giving birth) : (Date) (Month) (Year)<br />
Lain-lain. (Sila nyatakan) : ……………………………………………………………………………..<br />
Others. (Please specify) : .........................................................................................................<br />
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6. Senarai dokumen sokongan (List of supporting documents)<br />
a) …………………………………………………………………………………………………………………<br />
b) …………………………………………………………………………………………………………………<br />
c) …………………………………………………………………………………………………………………<br />
d) …………………………………………………………………………………………………………………<br />
7. Nama, alamat dan nombor telefon penyokong (Name, address and telephone numbers of referees)<br />
Nama (Name) Alamat (Address) Rumah (House) Bimbit (Handphone)<br />
a)<br />
b)<br />
......................................................................... ..............................<br />
Tandatangan pemohon (Applicant’s signature)<br />
Tarikh (Date)<br />
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Arahan untuk <strong>Borang</strong> 2 (JLKN /P/:02/Pin 2/10)<br />
1. Isi borang dengan HANYA menggunakan huruf besar dan pen mata bola. <strong>Bagi</strong> memastikan pemprosesan segera permohonan tuan / puan,<br />
sila pastikan butir-butir adalah diisi dengan betul, tepat dan mudah dibaca. <strong>Permohonan</strong> yang mengandungi maklumat yang tidak tepat atau<br />
tidak boleh dibaca tidak akan dilayan.<br />
2. Semua permohonan bagi perakuan penangguhan hendaklah dibuat dalam masa sepuluh (10) hari selepas penyiaran perintah Menteri yang<br />
menghendaki peserta menjalani Latihan Khidmat Negara atau dalam tempoh masa yang dipanjangkan sebagaimana yang boleh dibenarkan<br />
oleh pihak berkuasa yang sepatutnya.<br />
3. Untuk meluluskan permohonan anda, sila pastikan <strong>Borang</strong> ini diisi dengan lengkap, ditandatangani dan dilampirkan dengan dokumen<br />
yang lengkap iaitu:<br />
3.1. <strong>Bagi</strong> yang akan menduduki peperiksaan utama<br />
3.1.1. Surat pengesahan rasmi daripada pihak sekolah, ATAU<br />
3.1.2. Surat pengesahan rasmi daripada Lembaga Peperiksaan Malaysia.<br />
3.2. <strong>Bagi</strong> yang sedang meneruskan pengajian<br />
3.2.1. Institusi Pengajian Tinggi Awam (IPTA)<br />
3.2.1.1. Salinan surat tawaran belajar daripada institusi pengajian tinggi yang dinyatakan tempoh pengajian dan disahkan<br />
salinan sebenar, ATAU<br />
3.2.1.2. Surat rasmi mengesahkan bahawa pemohon sedang menghadiri kursus (sila nyatakan tempoh pengajian)<br />
daripada institusi pengajian tinggi<br />
3.2.2. Institusi Pengajian Tinggi Swasta (IPTS)<br />
3.2.2.1. Salinan surat tawaran belajar daripada institusi pengajian tinggi yang dinyatakan tempoh pengajian dan disahkan<br />
salinan sebenar, DAN<br />
3.2.2.2. Salinan resit pembayaran yuran pengajian (TERKINI) yang telah dibayar (sekurang-kurangnya ½ daripada<br />
jumlah yuran sebenar) dan disahkan salinan sebenar. ATAU<br />
3.2.2.3. Salinan surat tawaran biasiswa dan disahkan salinan sebenar.<br />
ATAU<br />
3.2.2.4. Surat rasmi mengesahkan bahawa pemohon sedang menghadiri kursus (sila nyatakan tempoh pengajian)<br />
daripada institusi pengajian tinggi<br />
3.3. Apa-apa keadaan yang akan menimbulkan kesusahan luar biasa<br />
3.3.1. Sedang hamil<br />
3.3.1.1. Surat pengesahan rasmi daripada doktor.<br />
3.3.2. Lain-lain kesusahan luar biasa<br />
3.3.2.1. Surat Sokongan yang jelas menyatakan kesusahan yang dialami oleh pelatih daripada Pesuruhjaya Sumpah,<br />
Majistret, Penghulu, Penggawa, Tok Sidang, Jaksa Pendamai, Komandan atau Pengetua Sekolah. DAN<br />
3.3.2.2. Salinan dokumen sokongan yang telah disahkan salinan sebenar.<br />
4. Salinan dokumen sokongan yang dikemukakan kepada Jabatan Latihan Khidmat Negara hendaklah disahkan salinan sebenar oleh<br />
Pesuruhjaya Sumpah, Majistret, Penghulu, Penggawa, Tok Sidang, Jaksa Pendamai, Komandan atau Pengetua Sekolah.<br />
5. Sekiranya permohonan pihak tuan / puan anda ditolak, anda boleh membuat rayuan kepada Majlis Latihan Khidmat Negara dengan<br />
menggunakan <strong>Borang</strong> 3 (JLKN/P/:03/Pin2/10). Rayuan itu bolehlah dialamatkan kepada:-<br />
6. Untuk makluman lanjut, sila hubungi:-<br />
Majlis Latihan Khidmat Negara<br />
Kementerian Pertahanan Malaysia<br />
Aras 2-5, Bangunan Zetro<br />
Jalan 9/27C, Seksyen 5<br />
Wangsa Maju<br />
53300 Kuala Lumpur<br />
Jabatan Latihan Khidmat Negara<br />
Kementerian Pertahanan Malaysia<br />
Aras 2-5, Bangunan Zetro<br />
Jalan 9/27C, Seksyen 5<br />
Wangsa Maju<br />
53300 Kuala Lumpur<br />
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Instructions for Form 2 (JLKN/P/:02/Pin 2/10)<br />
1. Kindly fill up this application form using ONLY block letters and ball point pen. To ensure prompt process of your application, please make<br />
sure that all details filled up are correct, accurate and legible. The National Service Training Department reserves the right to reject<br />
application that is incomplete.<br />
2. All applications for a postponement certificate must be made within ten (10) days after the publication of the order of the Minister requiring<br />
participants to undergo national service training or within such extended time as the proper authority may allow.<br />
3. To expedite this application, please make sure that this form is filled up completely, signed by the applicant and enclosed with all the<br />
required documents:<br />
3.1 For those that will be sitting for a major examination<br />
3.1.1 A formal letter from the current school, OR<br />
3.1.2 A formal letter from the Examination Council of Malaysia.<br />
3.2 For those who are pursuing studies<br />
3.2.1 Higher Educational Institution (Public)<br />
3.2.1.1 A certified copy of the Letter of Offer stating the duration of the course by the current Higher Educational<br />
Institution that the applicant is attending, OR<br />
3.2.1.2 A formal letter certifying that the applicant is attending the course (state the course duration) by the current<br />
Higher Educational Institution.<br />
3.2.2 Higher Educational Institution (Private)<br />
3.2.2.1 A certified copy of the Letter of Offer stating the duration of the course by the current Higher Educational<br />
Institution that the applicant is attending, AND<br />
3.2.2.2 A certified copy of the receipt (LATEST) proving payment of fees to the current Higher Educational Institution that<br />
the applicant is attending, OR<br />
3.2.2.3 A certified copy of the Scholarship Offer Letter proving that the course that the applicant is attending will be<br />
sponsored by a third party.<br />
3.2.2.4 A formal letter certifying that the applicant is attending the course (state the course duration) by the current<br />
Higher Educational Institution.<br />
3.3 Any other circumstances that will give rise to exceptional hardship<br />
3.3.1 Currently pregnant<br />
3.3.1.1 A formal confirmation letter from a doctor.<br />
3.3.2 Other exceptional hardship<br />
3.3.2.1 A formal appeal letter certified by a Commissioner for Oath, Magistrate, Penghulu, Penggawa, Tok Sidang,<br />
Justice of Peace, Commandant or School Principal certifying that the applicant is undergoing that particular<br />
hardship. AND<br />
3.3.2.2 A certified copy of any supporting documents proving that the applicant is undergoing that particular hardship.<br />
4. All documents submitted to the National Service Training Department must be certified true copies by a Commissioner for Oath, Magistrate,<br />
Penghulu, Penggawa, Tok Sidang, Justice of Peace, Commandant or School Principal.<br />
5. If your application is rejected, an appeal shall lie to the National Service Training Council by using form JLKN/P/:03/PIN 2/10. The appeal<br />
shall be addressed to :-<br />
National Service Training Council<br />
Ministry of Defence Malaysia<br />
Aras 2-5, Bangunan Zetro<br />
Jalan 9/27C, Seksyen 5<br />
Wangsa Maju<br />
53300 Kuala Lumpur<br />
OR<br />
6. For further enquiries, please contact :<br />
National Service Training Department<br />
Ministry of Defence Malaysia<br />
Aras 2-5, Bangunan Zetro<br />
Jalan 9/27C, Seksyen 5<br />
Wangsa Maju<br />
53300 Kuala Lumpur<br />
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