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BORANG PROFAIL PETUGAS PRU KE-15
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PARLIMEN P.065 IPOH BARAT
DUN
DUN BUNTONG
DUN BERCHAM
DUN KEPAYANG
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KOD DAN NAMA DAERAH MENGUNDI
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PUSAT MENGUNDI
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NO. TEMPAT MENGUNDI/SALURAN
(JIKA BERKENAAN)
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NO. KAD PENGENALAN BARU
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NO. KAD PENGENALAN LAMA
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NAMA
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JAWATAN SEMASA PRU KE-15
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KETUA TEMPAT MENGUNDI (KTM)
KERANI PENGUNDIAN/ MENGIRA UNDI (KP/MU)
PENYELIA PUSAT MENGUNDI (PPM)
KERANI PENYEMAK DAFTAR PEMILIH (KPDP)
PEMANDU ARAH PUSAT MENGUNDI (PAPM)
JANTINA
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LELAKI
PEREMPUAN
TARIKH LAHIR
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MM
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DD
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YYYY
ALAMAT TETAP
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PEKERJAAN SEKARANG
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NAMA JABATAN DAN ALAMAT TEMPAT BERTUGAS
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NO. TEL. RUMAH / PEJABAT
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NO. TEL. BIMBIT
*
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NOMBOR AKAUN BANK
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NAMA DAN ALAMAT BANK
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