Borang PSPK 1/2005 (Pind
Borang PSPK 1/2005 (Pind. 2/07)
BAHAGIAN PENTADBIRAN, UiTM CAWANGAN KEDAH
|BORANG PERMOHONAN |
| |
|Surat Pengsahan Kakitangan : Tujuan untuk _______________________________________________________ |
|Surat Pengesahan Hospital/Klinik : Nama Hospital/Klinik ______________________________________________ |
|Surat Pinjaman Bank : Nama Bank dan Alamat _____________________________________________________ |
Nama : ________________________________ Jawatan : ______________________
No. Pekerja : ________________________________ Gred : ______________________
No. Kad Pengenalan : ________________________________ Gaji Pokok : ______________________
Tarikh Mula Berkhidmat : ________________________________ Elaun Khidmat Awam : ________________
Tarikh Disahkan Jawatan : ________________________________ Elaun Perumahan : ________________
Tempoh Berkhidmat : ________________________________ Elaun Sara Hidup : ________________
Opsyen Pencen : *56 / 58 Tahun Lain-Lain Elaun (Nyatakan) :-
Taraf Jawatan : Tetap/Kontrak/Sementara 1.) ___________________________
Nama Pesakit : ________________________________ 2.) ___________________________
(Untuk Permohonan Surat Pengesahan Hospital Sahaja) 3.) ___________________________
Tandatangan : ______________________
Tarikh : ___________________________
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