KEMENTERIAN PERDAGANGAN DALAM NEGERI DAN HAL EHWAL PENGGUNA MINISTRY OF DOMESTIC TRADE AND CONSUMER AFFAIRS BORANG

PENYERTAAN PARTICIPATION FORM ANUGERAH KEDAI HARGA PATUT 2007/2008 FAIR PRICE SHOP AWARDS 2007/2008 ARAHAN/INSTRUCTIONS 1. Sila gunakan 1 borang untuk 1 syarikat / perniagaan. Use only 1 form for 1 company / business. Sila sertakan senarai premis perniagaan / cawangan yang ingin dipertandingkan seperti di Format A. Please attach the business outlets / the list of branches to be enrolled in this awards competition as in Format A. Sila sertakan bersama senarai harga barang yang dijual di premis perniagaan yang ingin dipertandingkan bagi tujuan penilaian. Senarai harga barang tersebut hendaklah sekurang-kurangnya 10 item dan tidak melebihi 40 item bagi setiap kategori. Please attach the price list for the products sold in the particular business outlet for the assessments purposes. The price list must be at least for 10 items and not exceeding 40 items for each category. Any application without the price list attached will be rejected. Borang permohonan yang telah diisi hendaklah dihantar kepada Pejabat Sekretariat Anugerah Kedai Harga Patut di alamat di bawah selewat-lewatnya pada 22 Mei 2007. Completed application forms shall reach the Secretariat for Fair Price Shop Awards Office at the following address on May 22, 2007: PEJABAT SEKRETARIAT ANUGERAH KEDAI HARGA PATUT BAHAGIAN PEMBANGUNAN PERNIAGAAN KEMENTERIAN PERDAGANGAN DALAM NEGERI DAN HAL EHWAL PENGGUNA Aras 5, Blok Menara, Lot 2G3, Presint 2 Pusat Pentadbiran Kerajaan Persekutuan 62623 PUTRAJAYA Tel: 03-8882 6201/8882 5774/8882 6397 Faks: 03-88825826

2.

3.

4.

MAKLUMAT PERNIAGAAN/BUSINESS INFORMATION 1.1 Nama dan Alamat Syarikat (Ibu Pejabat):
Companys Name and Address

(Headquarters)
1.2 No. Pendaftaran Perniagaan / Syarikat: Business / Company Registration No. 1.5 Tarikh Mula Beroperasi: Business Commencement Date

1.3 1.4

No. Telefon: Telephone No. e-Mel: e-Mail

1.6

No. Faks: Fax No.

JENIS BARANG/CATEGORY OF PRODUCT 2.1 Barang Kulit / Kasut / Beg Leather Products / Bag/ Shoes Barang Elektrik dan Elektronik Electrical and Elektronic Products Home Electrical Appliances Barang Kraftangan & Antik Handicraft and Antique Products Pottery, Pewter & Silverware Barang Kemas / Aksesori Jewellery Tekstil / Pakaian Textile / apperal / garment Batik / Songket Batik / Songket Kamera Camera 2.8 Jam Tangan Wrist Watch Kosmetik / Wangian Cosmetics / Fragrances

2.2

2.9

2.3

2.10 DVD/VCD/CD/Kaset DVD/VCD/CD/Cassettes

2.4

2.11 Alat Telekomunikasi Telecommunication Devices 2.12 Buku / Majalah Books / Magazines 2.13 Barang Optik / Cermin Mata Optical products / Glasses 2.14 Komputer dan Aksesori Computer and Accessories

2.5

2.6

2.7

KEAHLIAN PERSATUAN/PERTUBUHAN PERNIAGAAN MEMBERSHIP IN BUSINESS ORGANIZATION/ASSOCIATION 3.1 Adakah anda menjadi ahli kepada mana-mana pertubuhan/persatuan perniagaan? (Sila nyatakan) Are you a member of any business organization/association? (Please state) (a) _________________________________________

(b) _________________________________________ PERAKUAN DAN PENGESAHAN

CERTIFICATION AND VERIFICATION

Saya mengesahkan bahawa barang yang diperagakan adalah tulin dan asli serta maklumat yang diberikan di dalam borang ini adalah betul. I hereby certify the originality of the products is true and the information given in this form is correct. Nama Name Jawatan Position : ____________________________ Tandatangan Signature Tarikh Date : _______________________

: ____________________________

: _______________________

Cop Syarikat Companys Stamp

KEGUNAAN PEJABAT OFFICE USE

No. siri: Series No.

SENARAI HARGA DISERTAKAN/TIDAK DISERTAKAN*. PRICE LIST ATTACHED/NOT ATTACHED* ______________________________ Tandatangan Signature

___________________ Tarikh Date

FORMAT A
SENARAI PREMIS PERNIAGAAN / CAWANGAN YANG INGIN DIPERTANDINGKAN
Saiz premis (meter persegi) Outlet floor size (sq. meter) Nombor Akaun Lesen Premis Perniagaan Account Number of Business Premise License

No.

Nama dan Alamat Premis Trading Name and Address of the Premise

No. Telefon Telephone No.

No. Faks Fax No.

Bil. Pekerja No. of Employees

Nama Pengurus Premis Name of Premise Manager

1 2 3 4 5 6 7 8 9 10 11 12