BORANG BANTAHAN

SEKOLAH KEBANGSAAN SERI PERMAI,

JALAN TENGAH, 19500 BAYAN LEPAS, PULAU PINANG.
ACARA :........................................................................................

NO. ACARA : ..............................................

AKHIR / SEPARUH AKHIR / SARINGAN:...........................................

LEKAKI / PEREMPUAN :.............................

PASUKAN :...................................................................
PASUKAN YANG BERSALAH
TEMPAT KESALAHAN
MASA KESALAH

BUTIR-BUTIR KESALAHAN
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TANDATANGAN PENGURUS PASUKAN

( UNTUK KEGUNAAN PEGAWAI )

TARIKH DAN MASA DITERIMA :.......................................

BAYARAN RM200.00 DITERIMA :..................................................

KEPUTUSAN
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REFERI
KEPUTUSAN
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PENGERUSI JURI RAYUAN