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HCE3088/F003/01

KOLEJ POLY-TECH MARA KOTA BHARU


PT 669 – PT 679, SEKSYEN 17,
15050 KOTA BHARU, KELANTAN
Tel: 09 – 746 2020 / 2021 Fax: 09 – 747 7877

REPORT OF DUTY NOTIFICATION This is to confirm that this student


has reported for duty in our organization.

STUDENT
Name : NUR SALSABILA BINTI MOHD RASHID
I.D. NO : KBN200810108
Organisation Name : TADIKA & TASKA CINTA SAYANG GEMILANG
Organisation Address : NO 1&2 JALAN NABIRA 1, TAMAN NABIRA 05350 ALOR
SETAR,KEDAH.
INDUSTRIAL SUPERVISOR
Name :___________________________________________
Designation :___________________________________________
Contact No. :___________________________________________
Email :___________________________________________
Signature :___________________________________________
Organisation Official Stamp

The completed form must be submitted or faxed to:

Che Mohamad Hamizan bin Che Wahab


Industrial Training Unit
Kolej Poly-Tech MARA Kota Bharu
PT 669 – PT 679, Seksyen 17,
15050 Kota Bharu, Kelantan
Tel : 09 – 746 2020 / 2021 Fax: 09 – 747 7877
Email : hamizan@gapps.kptm.edu.my

If this form is not returned within the stipulated date, it will be assumed that the student
is not registered and did not report for duty. Hence, no evaluation will be made on the
student.

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