LAMPIRAN T1BUTIR-BUTIR CALON UNTUK TAPISAN KEUTUHAN SURUHANJAYA PENCEGAHAN RASUAH MALAYSIA (SPRM) TAHUN 2015 (MANDATORI)

PERINGATANSemua ruangan hendaklah dipenuhkan. Jika tidak berkenaan tulis TIDAK BERKENAAN jika tiada, tulis TIADA.A. 1.GELARAN:____________________________________________________

2.NAMA:____________________________________________________

3.NO. KAD PENGENALAN

2.1 (BARU)_____________________2.2 (LAMA)__________________________

4.NO. PASPORT/NO. POLIS/ NO. TENTERA :(JIKA ADA, SILA NYATAKAN) __________________________________

5.TARIKH LAHIR :_____________________ 6. TEMPAT LAHIR : ___________________

7.BANGSA : _________________________ 8. AGAMA : _________________________

9.JANTINA : ______________________ 10. WARGANEGARA : ____________________

11.GRED JAWATAN TERKINI : _______________________________________________

12.GELARAN JAWATAN TERKINI : ___________________________________________

13.SKIM PERKHIDMATAN : _________________________________________________

14.GAJI HAKIKI SEBULAN : _________________________________________________

15.TEMPAT BERTUGAS : _____________________________TEL:__________________ ___________________________________________________

16.ALAMAT TEMPAT : ______________________________________________________BERTUGAS ______________________________________________________ ______________________________________________________ ______________________________________________________

17.ALAMAT RUMAH : _________________________________TEL:__________________ ______________________________________________________ ______________________________________________________ ______________________________________________________

18.EMEL RASMI PEGAWAI : _________________________________________________

BUTIR-BUTIR PASANGAN CALON (Jika Berkaitan)B.1. NAMA ISTERI / SUAMI :____________________________________________________________________________________________________________________________________________2.NO. KAD PENGENALAN ISTERI / SUAMI :2.1 (BARU) : ________________________2.2 (LAMA) : __________________

3.NO. PASPORT/NO. POLIS/ NO.:TENTERA PASANGAN (JIKA ADA, SILANYATAKAN)___________________________________

4. JAWATAN / PEKERJAAN ISTERI / SUAMI :__________________________________________________________________________________________________________________________________________________________________________________________________________________5.ALAMAT PEJABAT ISTERI / SUAMI :__________________________________________________________________________________________________________________________________________________________________________________________________________________DENGAN INI, SAYA SEPERTI NAMA DI ATAS MENGESAHKAN MAKLUMAT MAKLUMAT DI ATAS ADALAH BENAR DAN SAHIH.

____________________________________________________(TARIKH) (TANDATANGAN PEMOHON)