7/25/2019 (716348920) LP_Am 17A IKH

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LEMBAGA PEPERIKSAANKEMENTERIAN PELAJARAN MALAYSIA

TUNTUTAN BAGI BAYARAN IKHTISAS

IKH

LP/Am 17A

1. Nama Penuh:(Daam Hu!u" Be#a!$

Pe%e!&'#aan(((((((((((((((((((((((((..Tahun(((((((((((((((.). N*.Ka+ Pen,enaan:

-. N*.a& u'a& Pen+a%a0an:

. Ja2a0an: 3.G!e+: 4. Ga5& P*'*' 7.N*.Ga5&:

6.Aama0 Iu Pe5aa0/Se'*ah: 8. N*. Te. Pe5: 19. N*.A'aun Ban':

8.1 N*.Te.B&m&0:

8.) N*.a'#&m&&: 19.1 Nama Ban':

11.Aama0 Rumah: 8.- Aama0 eme:

19.) a2.Ban':

1).Nama Ma0a%ea5a!an: 1-.K*+ Ke!0a#: 1 . N*.K*+ Peme!&'#a:

13.Nama Pu#a0/Tem%a0:(Un0u' +&& *eh #emua Pen,a2a#$

14. N*.Pu#a0:

17. Ba;a!an Pen,e*a:

17.1 Ba;a!an a,& a&na&n %e!an0&'an RM

17.) Ba;a!an a,& Pen;e&a Ka2a#an/Pen;e&a Ma0a Pea5a!an/Ke0ua Pen,a2a#/Pen.Pen,a2a# RM..

Jumlah Kecil (17.1 + 17.2)

K*+ R&n,,&0 Sen

A

16 Ba;a!an a,& Ah& Pane/Pen,,ua/Pen;ea!a#/Pen0a'#&!: B

18.Ba;a!an Peme!&'#aan:

18.1 .'e!0a# 5a2a%an 0eah +&%e!&'#a a,& ma0a %ea5a!an 0e!#eu0 +en,an 'a+a! RM#ena#'ah(#e%e!0& +aam *!an, %e!un0u'an %eme!&'#aan$

7/25/2019 (716348920) LP_Am 17A IKH

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=P*0*n, ;an, 0&+a' e!'enaan

==N;a0a'an #ama a+a Pen,a!ah/Ke0ua Un&0/Ke0ua Pa#u'an/Pen;e&a Ka2a#an/Ke0ua Pen,a2a# a0au a&na&n %e,a2a& ;an, e!0an,,un,5a2a