SPECIAL ALLOWANCE COVID19 (FEBRUARY 2021) - APPLICATION FORM

PHASE 3 COVID 19 SPECIAL ALLOWANCE COVID19 (FEBRUARY 2021) - APPLICATION FORM

BORANG PERMOHONAN – ELAUN KHAS COVID19 FASA 3 BAGI BULAN FEBRUARI 2021
SECTION A DETAILS OF APPLICANT
BAHAGIAN A MAKLUMAT PEMOHON
Name
(Nama)
No. IC
(IC No.)
Personnel No
(No Kakitangan)
Position Division
(Jawatan) (Bahagian)
Cost Centre E-mail Address
(Pusat Kos) (Alamat E-mel)
Office No Handphone No.
(No Telefon Pejabat) (No Telefon Bimbit)

SECTION B WORKING DAYS DETAILS

BAHAGIAN B MAKLUMAT HARI BEKERJA
Working Days 1 February 2021 9 February 2021 17 February 2021 25 February 2021
(Hari Bekerja)
2 February 2021 10 February 2021 18 February 2021 26 February 2021

3 February 2021 11 February 2021 19 February 2021 27 February 2021

4 February 2021 12 February 2021 20 February 2021 28 February 2021

5 February 2021 13 February 2021 21 February 2021

6 February 2021 14 February 2021 22 February 2021

7 February 2021 15 February 2021 23 February 2021

8 February 2021 16 February 2021 24 February 2021

Total Working Days

(Jumlah Hari Bekerja)
___________ Days

SECTION C SIGNATURE OF APPLICANT

BAHAGIAN C TANDATANGAN PEMOHON
I have read, understood and agree to the Terms & Conditions. If deemed false, disciplinary action shall be imposed to
me.
Saya telah membaca, memahami dan bersetuju dengan Terma & Syarat yang telah ditetapkan. Sekiranya perkara di atas
adalah palsu, maka tindakan tatatertib boleh dikenakan ke atas saya.

……………………………….......... ……………………………….......
Name & Signature Date
(Nama & Tandatangan) (Tarikh)

SECTION D SUPERVISOR VERIFIER

BAHAGIAN D PENGESAHAN PENYELIA

……………………………….......... ……………………………….......
Name & Signature Date
(Nama & Tandatangan) (Tarikh)

Please email / submit the completed form to the respective HCBD unit / division
Sila e-mel / hantar borang yang lengkap kepada HCBD unit / bahagian masing-masing

Confidential Version 1.0 Issued: February 2021