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BORANG PENILAIAN RISIKO WABAK COVID-19 DARI ZON MERAH
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* Indicates required question
MERENTAS DAERAH/NEGERI
*
KELUAR DAERAH/NEGERI
MASUK DAERAH/NEGERI
ALAMAT MERENTAS DAERAH/NEGERI :
*
Your answer
KATEGORI KENDERAAN:
*
PEMANDU BAS
PEMANDU LORI
LAIN-LAIN
Required
NAMA :
*
Your answer
NO KAD PENGENALAN :
*
Your answer
TARIKH MERENTAS
*
MM
/
DD
/
YYYY
NO TELEFON :
*
Your answer
ALAMAT SEMASA :
*
Your answer
TARIKH TERDEDAH DENGAN KES POSITIF SEKIRANYA ADA :
MM
/
DD
/
YYYY
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