KOMPUTER RIBA PERCUMA

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KOMPUTER RIBA PERCUMA

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Email *

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NAMA *

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NO KAD PENGENALAN *

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ALAMAT RUMAH *

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NO TELEFON (cth 012 - 411xxxx) *

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BILANGAN ANAK-ANAK YANG BERSEKOLAH *

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1

2

3

4

5

6

7

8

9

PENDAPATAN IBU BAPA SETIAP BULAN *

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RM1000 KE BAWAH

RM1001 - RM2000

RM2001 - RM3000

RM3000 KE ATAS

NAMA SEKOLAH *

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TINGKATAN ANAK YANG MEMOHON *

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Darjah 1

Darjah 2

Darjah 3

Darjah 4

Darjah 5

Darjah 6

Tingkatan 1

Tingkatan 2

Tingkatan 3

Tingkatan 4

Tingkatan 5

Tingkatan 6

Kolej/Matrikulasi

Universiti

Kawasan ADUN *

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DUN Machang Bubok

DUN Padang Lalang

DUN Berapit

Lain-lain

Bangsa *

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Melayu

Cina

Indian

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