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ETR 300

ENTREPRENEURSHIP
"BUSINESS PLAN"

FRESH CHICKEN FARM


NAME OF PARTNERS:
1.
2.
3.
4.

MOHAMAD SHUKRY B. MAKSAH


MUHAMMAD FAIRUZ B. JOHARI
MUHD. NURFAIZ B. BAHARUDDIN
AHMAD LUQMAN B.
MOHAMED SHAIHANI

2003230540
2003231714
2003231634
2003230883

Prepared For:

EN MALIKI B IBRAHIM (FKE)


EN HUSNY B BASIR (MEDEC)

DIPLOMA IN ELECTRICAL AND ELECTRONIC ENGINEERING

FACULTY OF ELECTRICAL ENGINEERING


DATE OF SUBMISSION
13 OCTOBER 2005

TABLE OF CONTENTS

PAGE

COVER LETTER

1-m

ACKNOWLEDGEMENTS
AGREEMENT OF BUSINESS
ORGANIZATION LOGO

iv
v-vii
1

INTRODUCTION
1.1 EXECUTIVE SUMMARY

1.2 BUSINESS PLAN PURPOSE

1.3 BACKGROUND OF OWNERS

1.4 PARTNER'S PROFILE

6-9

ADMINISTRATION PLAN

10

2.0 INTRODUCTION TO THE ORGANIZATION


i.

VISION

11

ii.

OBJECTIVE

12

iii.

BUSINESS ADDRESS

iv.

LOCATION PLAN

13

v.

TYPES OF BUILDING AND INFRASTRUCTURE

14

a) OFFICE LAYOUT

15

2.1 ORGANIZATION CHART OF FRESH CHICKEN FARM

16

2.2 LIST OF ADMINISTRATION PERSONNELS

17

2.3 SCHEDULE OF TASK AND RESPONSIBLITIES

18-20

2.4 SCHEDULE OF REMUNERATION

20

2.5 LIST OF OFFICE EQUIPMENTS AND SUPPLIES

21

2.6 ADMINISTRATION BUDGET OF FRESH CHICKEN FARM

22

MARKETING PLAN
3.0 INTRODUCTION

23
24

3.1 PRODUCT OR SERVICE DESCRIPTION


3.2 TARGET MARKET

25

3.3 MARKET SIZE


3.4 MAIN COMPETITORS
/.

STRENGTHS OF COMPETITORS

ii.

WEAKNESSS OF COMPETITORS

iii.

STRENGTHS OF FRESH CHICKEN FARM

3.5 MARKET SHARE


3.6 SALES FORECAST
3.7 MARKETING STRATEGIES

26
27

28
29 - 30
31

i.

PPRODUCT

ii.

PRICING

iii.

PLACE/DISTRIBUTION

32

iv.

PROMOTIONS

33

3.8 MARKETING BUDGET

34

OPERATION PLAN

35

4.0 INTRODUCTION

36

4.1 FLOW CHART OF OPERATION ACTIVITIES

37

i.
ii.

FLOW CHART CONVENTIONAL SYMBOLS

38

PROCESS FLOW CHART

39

4.2 OPERATIONS SYSTEM


i.

READY OF BOILER CLOSED HOUSE

ii.

INSTALL THE NECESSARY BROODING EQUIPMENT

40

a. DRINKER SYSTEM

41

b. FEEDING SYSTEM

42

c. PAD COOLING SYSTEM

43

iii.

CHICK PLACEMENT

iv.

CHICK QUALITY

v.

DAILY CONTROL AND QUALITY CONTROL

44

a. VENTILATION

45

b. FEED AND WATER

46

c. LIGHT

47

d. DISEASE CONTROL
e. BIO-SECURITY
vi.

GROWING PHASE

48

a. UNIFORMITY
b. MODIFICATION OF FEED AND NUTRIENT INTAKE
c. LIGHTING PROGRAMS
vii.

CATCHING PROCESS

viii.

DISINFECTION

49
50

4.3 BUSINESS OPERATION TIME


4.4 CAPACITY PLANNING

51

4.5 TOTAL COST

52

4.6 MATERIAL REQUIREMENTS (INPUT)


4.7 LIST OF OPERATIONS PERSONNEL

53

4.8 SCHEDULE OF TASKS AND RESPONSIBILITIES


4.9 SCHEDULE OF REMUNERATION
4.10 MACHINE AND EQUIPMENT
i.

INFRASTRUCTURE DEVELOPMENT

ii.

EQUIPMENT AND MACHINERY

54
55-57

4.11 OPERATIONS SPACE LAYOUT PLAN

58

4.12 OPERATION OVERHEAD

59

4.13 OPERATION BUDGET

60

FINANCIAL PLAN

61

5.0 INTRODUCTION

62

i.

OBJECTIVE

63

5.1 PROJECT IMPLEMENTATION COST SCHEDULE

64

5.2 SOURCE OF FINANCE SCHEDULE

65

5.3 SUPPORTING SCHEDULES

66

i.

LOAN OF AMORTIZATION SCHEDULE

ii.

FIXED ASSET DEPRECIATION SCHEDULE

67 - 71

5.4 PROFORMA FINANCIAL STATEMENTS


i.

CASH FLOW PROFORMA (ANUALLY)

ii.

PROFORMA PROFIT AND LOSS ACCOUNT FRESH

72 - 73
74

CHICKEN FARM
iii.

PROFORMA BALANCE SHEET ACCOUNT FRESH

75

CHICKEN FARM
CONCLUSION / RECOMMENDATIONS
APPENDIXES

76 - 77
78

Diploma In Electrical and Electronic Engineering,


Faculty of Electrical Engineering,
Mara University of Technology,
Shah Alam Campus,
40450 Shah Alam,
Selangor.

En. Husny B. Basir


Lecturer of Fundamentals of Entrepreneurship (ETR 300)
MEDEC,Blok 13
Intekma Resort & Convention Centre (Level 4)
40450 Shah Alam
Selangor Darul Ehsan
Dear Sir,
Submission Of Business Plan
Referring to the matter above, Fresh Chicken Farm would like to submit the business
plan for your analysis and references. Fresh Chicken Farm would start our business with
partner and address mentioned below:Details of partners are as follows:1. Mohamad Shukry B. Maksah

2003230540

2. Muhammad Fairuz B. Johari

2003231714

3. Muhd. Nurfaiz B. Baharuddin

2003231634

4. Ahmad Luqman B. Mohamed Shaihani

2003230883

Business address:-

FRESH CHICKEN FARM


Lot 3307, Batu 7,
Lorong Sarkawi,
Jalan Kebun
42 450 Klang,
Selangor Darul Ehsan

We have tried our best to prepare this business plan with all data compiles for your good
judgments. This working paper is a group effort and all experiences gained are valuable
lesson for entire group members.

We hope that our business plan will satisfy your requirement for this subject (ETR 300). We
also hope that our business plan can give some benefit to other people especially as a
reference material for the future.

Yours sincerely,

(Mohamad Shukry B. Maksah)


General Manager

(Muhd. Nurfaiz B. Baharuddin)


Marketing Manager

lammad Fairuz B. Johari)


Operation Manager

(Ahmad Luqman B. Mohamed Shaihani)


Financial Manager

in

ACKNOWLEDGEMENT
We would like to thank ALLAH S.W.T for His blessings that we were able to
finish this assignment. We would also like to thank our lecturers, En Maliki and En
Husny for the guidance and lectures that have given us a clear view on how to document
our business plan.

In preparing the plan, we have also come across several individuals and
interviewed them for information gathering. We would like to extend our gratitude to
them particularly En Baharen and En Azaruddin because of their willingness to spend
their time in answering our questions regarding chicken business.

Last but not least, we would also like to thank our classmates who have helped us
in answering questions related to the business plan. Their generosity and assistance are
greatly appreciated.

IV

AGREEMENT OF BUSINESS

The agreement letter has been made on 28 July 2005 between 4 partners of the
company and below is the list of partners and the agreed terms.

Mohamad Shukry B. Maksah

Muhd. Nurfaiz B. Baharuddin

850628-10-5221

850720-14-5883

41 Jin Sri Damak 50,

167 Jin. Tun Abdul Razak,

Taman Sri Andalas,

Taman Sri Andalas,

41200 Klang,

41200 Klang,

Selangor.

Selangor.

Muhammad Fairuz Bin Johari

Ahmad Luqman B. Mohamed Shaihani

851107-07-5455

850515-10-5559

99 Jin. Sri Damak 22,

11 Jin. SriSedeli5,

Taman Sri Andalas,

Taman Sri Andalas,

41200 Klang,

41200 Klang

Selangor.

Selangor.

Partners of Fresh Chicken Farm have agreed to all the terms and conditions that have
been discussed and all the terms and conditions of the company are stated as below:
1. The partners have agreed with the name of the company Fresh Chicken Farm
and all businesses with the company should apply the mailing address as
below:
FRESH CHICKEN FARM
Lot 3307, Batu 7,
Lorong Sarkawi,
Jalan Kebun
42450 Klang,
Selangor Darul Ehsan
2. All partners agree with the reasonable salaries given to them.
3. Documents such as profit and loss statement, balance sheet and other confidential
documents shall not be revealed to others.
4. Every partner is entitled to participate in the management of the business.
5. Every partner knows of the risk and agrees that the liability for the company is
unlimited and we are ready to pay off all liabilities for the company with own
properties.

VI

Below are the signatures of all partners that have agreed with all the terms given above.

MOHAMAD SHUKRY B. MAKSAH


I/C: 850628-10-5221

MUHAMMAD FAIRUZ B. FOHARI


I/C: 851107-07-5455

MUHD. NURFAIZ B. BAHARUDDIN


I/C: 850720-14-5883

AHMAD LUQMAN B. MOHAMED SHAIHANI


I/C: 850515-10-5559

Vll

FRESH CHICKEN
FARM
DEFINITION OF THE LOGO

FRESH CHICKEN FARM

| z ) Represent the name of our company.

CIRCLE SHAPE

l~~> Represents unity between partners and all the


employees.

WHITE BIRDS

BLUE

Represent our products

Hy Represent the courage and hard work among the


partners and employees.

1.1 EXECUTIVES SUMMARY


This business is based on partnership where it consists of four (4) members.
The members consist of the General Manager, Administration Manager, Marketing
Manager, Operational Manager and Financial Manager. The business capital is
amounted to RM372,410 where the total contribution of each member is RM79,910
and the rest is from the Bank Pertanian loan.

FRESH CHICKEN FARM is a company related to the breeding the chicken


meat. Our market focus is for the Pertanian Pertiwi, a company that directly deals
with us, they will supply the day-old-chicks with the certain price and buy the chicken
back when it reach at certain age (normally at 50 days). For those who are interested
to buy the fresh chickens, we can't sell to them due to our contract with the Pertanian
Pertiwi.
Our business will be expected to commence on 2006 and our vision is to make
our company a well-known, established and satisfied by our customer in order to
expand our capacity of chickens and to attract other companies to deal with us with a
better price. This will be realized by the full cooperation and efforts among the
partners to promote this company.
Based on the objectives above, we are venturing into livestock industry.
Chickens' farming has the potential of being a profitable business if it's done in
modern way with large scale and systematically managed.
We will expect that our business will become more developed in the near
future because the demand for the chicken's meat is high and not many breeders use
the closed system. This will give more advantages for us to make our product more
profitable and stabile in the long run.

1.2

BUSINESS PLAN PURPOSE

The main purpose of this business plan is for the reference of several
audiences / parties such as:

1. The Entrepreneurs (Fresh Chicken Farm's managers).


To better understand the purpose of the business and act as guideline to
manage the business effectively and efficiently.

2. Financial Institutions.
Assist and help the financial institution to evaluate the capability of the
proposed project and provide loan for the business. Financial institution
involved in this business project is Bank Pertanian Malaysia.

3. Suppliers.
Help convince suppliers of the viability of our business venture thus benefiting
both the suppliers and our company in the long term business arrangement.

4. Company Staffs / Workers.


Help workers to understand the business's goals and objectives and give a
guideline to them regarding their job duties and responsibilities.

5. Customers.
Persuade and influence our customers regarding the products being offered
and gives assurance and confidence to them to have business with us.

13

BUSINESS BACKGROUND

Below is the business background for our company:Name of Business/Company : FRESH CHICKEN FARM
Address

: Lot 3307, Batu 7,


Lorong Sarkawi,
Jalan Kebun,
42450 Klang,
Selangor Darul Ehsan.

Telephone

: 03-31222372

Fax No.

: 03-31222375

Form of Business

: Partnership

Main Activities

: Providing services of breeding the chicken meat.

Date of Registration

: In progress

Number of Registration

: hi progress

Date of Commencement

: hi progress

Initial Capital

: RM 79,910

Name of Bank

: Bank Pertanian Malaysia

Account No.

: 40950003456

1.4

1.

PARTNER'S PROFILE

Name

Mohamad Shukry B. Maksah

Identity Card Number

: 850628-10-5221

Permanent Address

: 41 Jin. Sri Damak 50, Taman Sri Andalas,


41200 Klang, Selangor.

Telephone No.

: 019-3079070

Date of Birth

:28 th June 1985

Age

: 20 years old

Marital Status

: Single

Academic Qualification

: Diploma In Electrical Engineering

Courses Attended

: Entrepreneurship

Skills

: Computer related

Experience

:None

Present Occupation

: Undergraduate

Previous Business

:None

Experiences

: None

2.

Name

Muhammad Fairuz B. Johari

Identity Card Number

: 851107-07-5455

Permanent Address

: 99 Jin. Sri Damak 22, Taman Sri Andalas,


41200 Klang, Selangor.

Telephone No.

: 017-3082892

Date of Birth

:7 t h November 1985

Age

: 20 years old

Marital Status

: Single

Academic Qualification

: Diploma In Electrical Engineering

Courses Attended

: Entrepreneurship

Skills

:None

Experiences

: None

Present Occupation

: Undergraduate

Previous Business

: None

Experiences

: None

3.

Name

Muhd. Nurfaiz B. Baharuddin

Identity Card Number

: 850720-14-5883

Permanent Address

: 167, Jalan Tun Abdul Razak, Taman Sri


Andalas, 41200 Klang, Selangor.

Telephone No.

: 012-6045320

Date of Birth

: 20th July 1985

Age

: 20 years old

Marital Status

: Single

Academic Qualification

: Diploma In Electrical Engineering

Courses Attended

: Entrepreneurship

Skills

: None.

Experiences

: None.

Present Occupation

: Undergraduate

Previous Business

: None

Experiences

:None

4.

Name

: Ahmad Luqman B. Mohamed Shaihani

Identity Card Number

: 850515-10-5559

Permanent Address

: 11 Jin. Sri Sedeli 5, Taman Sri Andalas,


41200 Klang, Selangor.

Telephone No

: 012-9157455

Date of Birth

: 15th May 1985

Age

: 20 years old

Marital Status

: Single

Academic Qualification

: Diploma In Electrical Engineering

Courses Attended

: Entrepreneurship

Skills

: None

Experiences

: None

Present Occupation

: Undergraduate

Previous Business

: None

Experiences

:None

Fl

yj J

7J

10

2.0 INTRODUCTION TO THE ORGANIZATION

Administration plan is first step of business to become more developed and


expounded in the future. It is important in every business. The effectiveness of
FRESH CHICKEN FARM is based on the administration that has been planned
systematically and followed by the proper planning before the business is established.
The important things that have been taken care of are well organization and
effectiveness in administration plan.
Several things that are included in this part are;
> Organization planning
> Organization chart
> Numbers of workers/labor
> Administration budget
> Office layout
> Remuneration Table
> Workers intensive
^ Position, responsibilities and specific task

Vision
It is FRESH CHICKEN FARM to be strength and famous farm over the world
as a quality and fresh "chicken" provider in order to fulfill an increase of market
demand for this favorite chicken by the year 2015. FRESH CHICKEN FARM should
be promoted to other countries to our vision that our local favorite chicken is to meet
a satisfying among foreigners.

11

Objective
1) Justly to compensate the employees and owners of FRESH CHICKEN
FARM.
2) Contribute to the development and growth of the country's economy and to
increase the percentage of Bumiputera involves in business
3) To create productivity among employees
4) To provide the best quality of "chicken" every time in order to attract more
customers

Business Address
Our business will be situated at the following address:
FRESH CHICKEN FARM
Lot 3307, Batu 7,
Lorong Sarkawi,
Jalan Kebun
42 450 Klang,
Selangor Darul Ehsan

12

b) Location Plan

LORONGAKTBAKSR"
MARDI
HOUSE AREA

JAUWKH

FRESH
CHICKEN
FARM

-mrnmm

KESAS HIGHWAY

FROM KUA1A LUMPUR

PUUWMDAH
ECONSAVE

TESCO
HOUSE AREA

PROTON
SERVICE
CENTER

FROM HAH ALAM

ESSO

BUWTTWGGJ
(AMPIINGJA^I
TEMPLE

GIANT
Shell

Hospital Besar
Klang

KLANG

13

Type of Building and Infrastructure


Among the facilities that are provided at our project site are:
1. Office
2. Toilet

We have chosen a project site which has all the necessary facilities and infrastructure
as a catalyst for the growth and development of our business, FRESH CHICKEN
FARM. Our business is situated only 45 minutes away from Kuala Lumpur through
KESAS highway.

Among the many infrastructures that can be found in the project site are:
a) An excellent highway system where it can facilitate the customers to frequent the
project site and buy our products. It will also make it more convenient for the
suppliers to come and supply the raw materials needed by our company.

b) Electricity power supply has already been provided by the Tenaga Nasional Berhad
along the Jalan Kebun.

c) Telephone line has already been made available by the Telekom Malaysia Berhad
and also water supply from the Water Department along Jalan Kebun.

14

OFFICE LAYOUT

<
)

1*-*

FINANCIAL
MANAGER

)GENERAL
MANAGER

i**

OPERATION
MANAGER

D
tF^

MARKETING
MANAGER

KEYS:

Chair

Computer

Sofa

Toilet

Telephone

White

Board

Table

15

2.1 ORGANIZATION CHART OF FRESH CHICKEN FARM

GENERAL MANAGER

ADMINISTRATION
MANAGER

FINANCIAL
MANAGER

OPERATION
MANAGER

MARKETING
MANAGER

WORKERS

WORKERS

The style of the organization chart is designed on functional style. The


organization structure on functional style is very effective to the any company which
are need peculiar specialize.

16

2.2 LIST OF ADMINISTRATION PERSONNELS

SERIES

POSITION

NO OF PERSONAL

General Manager

Operation Manager

Administration Manager

Marketing Manager

Financial Manager

Trained Workers

TOTAL

17

2.3 SCHEDULE OF TASK AND RESPONSIBLITIES

POSITION

TASKS AND RESPONSIBILITIES

Making connection and establishing contact


with

the

main

supplier,

PERTANIAN

PERTIWI SDN BHD.

Form the business policies and guidelines

Making decisions and solve all problems


faced by Fresh Chicken Farm.

Help the Marketing Manager to promote the


chicken products.

General Manager

Find out more information and do research


about setting up and operating a chicken's
farm successfully.

Choose quality livestock from the supplier,


PERTANIAN PERTIWI SDN BHD.

Responsible and liable for all business risks or


any problems regarding business or workers

To forecast sales and income

To administrate the business structure

Lay out all plans and ensure that all things are
done according to plans

Determine the wages and salaries received by


workers and contribute the percentage of the
salaries to EPF and SOCSO.

Make the decisions regarding administrative


tasks and office works.

Responsible for all mails and correspondences


connected with the business.

Administration Manager

To assist general manager in the business

To involve in guiding a new worker in case of


a new recruitment

Help to achieve the business target by


implementing business ideas and strategies

18

Find other strategies to help increase sales

Analyze the strengths and weaknesses of


competitors.

Marketing Manager

Handle

the

advertisement,

banners

and

signboard placement.

Make sure the customer receive good service.

Able to interact and try to make the customers


to have confidence in our business

To analyze the opportunity in the economy,


choose and grab the opportunity based on the
business

Find and place a suitable pricing for every


chicken product sold.

Deal in the buying of food for the chicken

Responsible for the training of new workers

Operations Manager

and monitor the job quality of all operation


workers.

Monitor th health of chickens.

To make sure that all stocks are in good


condition

To make sure all the stocks are enough to


meet the demand

Informing suppliers when there are extra


orders needed

Prepare the company financial report

Keep all the financial records and business


accounts in the safety place.

Record and monitor all the income received


and expenses incurred by the business.

Financial Manager

Responsible for controlling and managing


company's financial capital and cash flow.

19

Advice the manager regarding the financial


matters.

Make a budget of business example financial


statement, profit, and loss account, and
balance sheet

Search for the information of capital and asset


activities.

2.4 SCHEDULE OF REMUNERATION

DESIGNATION

NO OF

MONTHLY

EPF

socso

EMPLOYEE

SALARY

(12%)

(2.5%)

TOTAL

(RM)

(RM)

(RM)

(RM)

General Manager

1,700.00

204.00

43.00

1,947.00

Operation Manager

1,300.00

156.00

33.00

1,489.00

Admin Manager

1,300.00

156.00

33.00

1,489.00

Marketing Manager

1,300.00

156.00

33.00

1,489.00

Financial Manager

1,300.00

156.00

33.00

1,489.00

Trained Workers

1,000.00

120.00

25.00

1145.00

TOTAL

7,900.00

948.00

200.00

9,048.00

20

2.5 LIST OF OFFICE EQUIPMENTS AND SUPPLIES

NO

1.

TYPE

QUANTITY

PRICE/UNIT

TOTAL

(RM)

(RM)

OFFICE EQUIPMENTS

a. COMPUTER (PARTNERS

2,500

CONTRIBUTION)
b. AIR CONDITIONER

1,180

1,180

c. TELEPHONE & FAX

1,000

1,000

d. FIRST AID

100

100

e. WHITE BOARD

120

120

f.

400

1,600

MACHINE

CABINET/FILE FOLDERS

g. ADDITIONAL

170

ACCESSORIES

6,670

TOTAL
2.

FURNITURES

a. CHAIRS
b. SOFA
c. TABLE

TOTAL

60

480

1 SET

1,100

1,100

150

600

2,180

21

2.7 ADMINISTRATION BUDGET OF FRESH CHICKEN FARM

TYPE

Fixed Asset

Monthly Expenses

Yearly Expenses

Cost

(RM)

(RM)

Salary, EPF, SOCSO

6,414

76,968

Stationary

50

600

Miscellaneous

100

1,200

500

6,000

(RM)
Fixed Asset:
Land &Building

138,000

Furniture

2,180

Office equipments

6,670

Renovation

Monthly Expenses:

Telephone bill

Other Expenses:
Registration & Licenses

100

1,200

Deposit

Insurance & Road Tax

Other Expenses

22

23

3.0 INTRODUCTION

Marketing is a social and managerial process by which individuals and group


obtain what they need and wants through creating and exchanging products and value
with others. It can be defined as an activity that are carried out systematically to
encourage and increase sales of products or services as long as the activities are in the
line with religious and ethical practices.
Marketing is basically an exchange activity that takes place between a
business entity and its customers. The customers can conclude individuals, others
business entities (e.g. wholesalers and retailers) and support organizations (e.g. banks
and government agencies). Marketing is a critical activity in any business because it
forms the backbone to the total business effort in achieving a profitable outcome.
Consequently, the challenge in any business is to produce and offer a product that
results in profit for the business and, more importantly, satisfies the target customer.
r
3.1 PRODUCT OR SERVICE DESCRIPTION

Our business will be name as 'FRESH CHICKEN FARM'... holding one


marketing concept where our operation, strategy and manufacturing are done
regarding customer's needs and wants. In the other words, the customer satisfy is a
major concerning in every effort and strategy to ensure that our business can be
compete and more longer in market.
We have chosen a business that deal with the distributor, whereby they are an
agreement that the distributor will supplies the chick to us, then we will breed its until
a certain level before the chicken return back to them. There are only 18,000 chicks
per batch that we will take. It takes a year the contract of this business.

24

3.2 TARGET MARKET

The target market is defined as the groups of customers that have needs and
wants that can be satisfied by the business through the supply of goods and services.
It's important for us to have a target market to determine our customers needs and
wants towards chicken.
Since that our business has a contract with other company, which is our
distributor, therefore, our target market is 'Pertanian Pertiwi Sdn Bhd'(distributor).
Our company does not have a specific area or outlet to distribute our product because
we have a deal with the distributor. In the agreement, it states that we will get the
supplies (chicks) from the distributor and after a certain level, we will sell it back to
the distributor.

3.3 MARKET SIZE

Market size refers to the total potential purchase of the target market. Since we
have a contract, so the market size is depend on the purchasing of our distributor.
According to our distributor, we had been informed that their annual sale is
RM15,779,840. Therefore this is our market size. The table below shows the target
market of their company.

OUTLET

EXPECTED PURCHASE
Per year (RM)

PERCENTAGE
(%)

Wet Market

5,52,944

35

Hotel

3,155,968

20

Restaurant

4,733,952

30

Factory / School Canteen

1,577,984

10

Individuals

788,992

15,779,840

100

TOTAL

25

3.4 MAIN COMPETITORS

In our business operating, there are many competitors that operate a same
business like us. Competitors actually refer to other businesses that offer similar,
substitute or an alternative products or services to the same target market. We have to
analyze the strengths and weaknesses of our competitors in term of size, experience,
and years in business, financial ability and product line in order to compete together
with them.
Here we have identify some entrepreneurial that operate chicken business
located in the same area:
Hj. Kamaruddin b Hj. Ellyas
Kim Too Siong
En Baharen M.Daie.

All the above competitors have been long in this business before we entered
the business. Therefore, most probably they have established themselves and have
more experience in facing towards customers. What can we do is trying to have a
good business and make the competitors as our activator to succeed in the business.

26

STRENGTHS OF COMPETITORS
> They have been in the business for a long time before us and make them
already have permanent customer.
> They have a large source of capital to expand their market.
> They have more experience in operating the business compared to us.
Customers know them well and more confident to work with them.

WEAKNESSS OF COMPETITORS
^ Their operation management is not systematically.
^ The price of the chicken is not suitable with the quality of the product selling.
> Their farm is 'open system', produce low quality product.
> Less promotion to spread widely their business.

STRENGTHS OF FRESH CHICKEN FARM


^ Our operating is more systematic to ensure that our chickens are grower in
better condition.
> Our price is suitable with the size of chicken selling.
> We care of the quality of the chicken selling to buyer.
> Applied high technology on the farm. (Close system)
> We have well in promotion and ensure a good relationship with our
distributor.
* Nevertheless, we have our weakness that we are still new in our business and have
less experience compared to other competitor.

27

3.5 MARKET SHARE

Market share refers to the estimated potential sales of the business after taking
into consideration of the market size and competitors influences. Based on our market
size, RM 15,779,840 we can estimate our 5% share of market.
The table below shows the market share before and after 'FRESH CHICKEN
FARM' entered market.

Name of

After

Before
%

Company

share

(RM)

Amount

Amount

(RM)

share

25

3,944,960

25

3,944,960

Kim Too Siong

20

3,155,968

20

3,155,968

En Baharen M.Daie

15

2,366,976

15

2,366,976

Others

40

6,311,936

35

5,522,944

788,992

100

15,779,840

Hj. Kamrauddin b.
Hj. Ellyas

'FRESH CHICKEN
FARM'
TOTAL

100

15,779,840

28

3.6 SALES FORECAST


Sales forecast is expected purchases from the identified target market. There
will be an increase in our sales every year for our three years forecast seems that the
high demand for chicken in the market. There is a possibility that the customers needs
a better quality of chicken and choose us as their new supplier.
The following table shows the forecasted sell for the first three years.
Sales Forecast for year 2006,2007 and 2008 (RM)
MONTH

NO OF

SELLING PRIZE

AMOUNT

UNIT (kg)

(RM/kg)

(RM)

January - February

41,055

3.20

131,376

March - April

41,055

3.20

131,376

May - June

41,055

3.20

131,376

July - August

41,055

3.20

131,376

September - October

41,170

3.20

131,744

November - December

41,170

3.20

131,744

246,500

3.20

788,992

Total-2007

246,500

3.20

788,992

Total - 2008

246,500

3.30

813,450

Total-2006

In our business, we have a certain period of time to produce our product.


Operation of our product will take about two month before it's will be market.
Therefore, we just can make a forecast per batch, which means every two-month we
will gain in sales.
We start our project in January and get 18,000 of chick from the distributor.
From the table above, our product that we sell to the distributor is 41,055, which is
17,850 of chicken with average weight 2.3kg in the first, second, and third batch (JanAug). We expect that 150 chicken will died. On the forth and fifth batch, there are
only 100 died. To achieve this target, we will make sure that our operation was good.
The distributor also will help us by giving an extra 200 of chicks in every batch. On
29

September to December, they will give us extra 250 of chicks because of the festival
season.
From the graph below, it shows that our selling forecast in year 2006, 2007
and 2008. In the agreement, the price for a chicken is fixed, RM3.20/kg. The graph
shows that the pattern of selling in year 2006 and 2007 is same and in 2008, it will
increase 3% by increasing our selling price to RM3.3O/kg while we renew our
agreement with the distributor.

Graph On Sales Forecast

136,000
135,000
134,000
Amount

133000

(kg)

132,000
131,000

_ _

n rr r

i
1

130,000
129,000

1 .,

D Year 2006
Year 2007
Year 2008

Month

30

3.7 MARKETING STRATEGIES


Our business operating is supplying the meat chicken. In this business, we are
dealing with other company as a distributor which they as an agent to distributed our
product. We supply the chicken and they processed the chicken for selling to the
customer. Therefore, our marketing strategy is to make the distributor more confident
towards our quality of product. In order to achieve our target, we have developed
appropriate marketing strategies to generate the sales from the target market. There
are four factors to be considered which are as follows;
a) Product
b) Price
c) Place (distribution)
d) Promotion

a) Product
Our farm provides a good quality of chickens, which are from a good
heredity (grade A) and free from infectious disease. We will operate our farm
carefully to ensure that it's always been satisfy by our distributor. In this business, the
distributor will give a guideline for us to control our quality of products. To achieve
the standard level of our product, we will make sure that our operation will operate
according to the guideline given. Besides, the distributor will come to our farm every
two weeks to make sure that our chickens have a good health.
Our business provides a clean environment of a farm, which is very important
for giving a view to our quality product. A good quality of chicken also comes from
their good quality of feed.

b) Pricing
The price of chicken is fixed based on our agreement with the
distributor. Otherwise, in order to put a price for our product, we are using
'competition-based pricing' concept and make a comparison regarding quality and

31

size of the chicken. The proper price fixed by our business is RM3.20/kg where
usually the price fixed by competitors is RM3.50/kg.

c) Place/Distribution
We have chosen Jalan Kebun at Klang as our project site based on some
factor;

Farm is far away from town and housing area

Farm have access to transportation and be able to operate all the time

Land are flat and have good drainage

The area is well ventilated

Seems that our location is in Klang , its will encourage the distributor to make a deal
with us.
d) Promotion
An impressive promotion is needed to ensure that our missions are achieved.
A step of promotion should be taken in order to achieve our vision to make everyone
known our potential and get a chicken supply from our company.
Promotions are based on;

Signboard
It's very important for each business to have a signboard to introduce the business
and let everyone know the location of the project site. Our business will have two
signboards that will be put in front of our office and the side of road that mention
the way to our farm.

Business card
Our business card will be given especially to our vendors who visit our farm.
It's make people know how to contact us as a manager to make a business or
directly come to our farm based on address given.

32

Website
We will make a business website for our company seems that Internet is the
most important communication tool among the communities nowadays. All
information regarding our business will be advertised in the homepage
MOHAMMAD SHUKEY
B. MAKSAH
(General Manager)

Fresh
GbkkenFarm

Lot 3307, Batu 7, Lorong


S&rkawi, Jalart Kebun,
42450 Klang,
Tel:03-31222372
H/p : 019-3079070
www. f reshchickenfa rm. com

MUHD NURFAIZ
B. BAHARUDDIN
(Marketing Manager)

Fresh
Chicken F&rtn

Lot 3307, Batu 7, Lorong


Sarkawi, Jalan Kebun,
42450 Klang,
Tel:03-31222372
H/p : 012-6045320
www. f reshchickenfa rm.com

MUHAMMAD FAIRUZ
B JOHARI
(Operation Manager)

Fresh
hickn Farm

Lot 3307, Batu 7, Lorong


Sarkawi, Jalan Elebun,
42450 Klang,
Tel: 03-31222372
H/p : 017-3082892
www. f reshchickenfa rm. com

33

AHMAD LUQMAN B.
MOHAMMED SHAIHANI
(Financial Manager)
Lot 3307, Batu 7, Loiong
Sarkawi, Jalan Kebun,
42450 Klang,
Tel: 03-31222372
H/p : 012-9157455
www. freshchickenfa rm. com

Fresh

3.8 MARKETING BUDGET


Remuneration Table Monthly
POSITION

MONTHLY

EPF

socso

TOTAL

SALARY (RM)

12%

2.5%

(RM)

(RM)

(RM)

156

33

Marketing

1300

1489

Manager

List Of Marketing Budget


Type

Fixed Asset Cost

Monthly Expenses

Other Expenses

(RM)

(RM)

(RM)

Fixed Asset
Signboard

500

Working Capital

Salary, EPF, SOCSO


Miscellaneous

200

Other Expenses

Business Card

100

34

35

4.0 INTRODUCTION

Operation Management
Operation management can be defined as the process of marshalling resources
to produce output through the transformation process. The operation process
comprises three main components, i.e. business input, transformation system and
output.
Business input refers to all resources required to produce a particular output.
Examples of input are manpower, raw materials, machines and equipment,
technology, information and capital. The transformation system refers to the activities
involved in transforming input into output. Among others, the processing system
involves planning of raw materials, designing of operational process, planning of
floor layout and distributing of manpower in the organization. Output refers to the end
product created as the result of the transformation process. Business output can be
categorized into either products or services. As input is transformed into output, it
acquires added value, whereby the value of the output is higher than the total input
value.
Our purpose focus in operational plan is to breed and to ensure chicken that
we supply is high quality to fulfill our customer needs and wants. With the quality,
exact time and place we planned at the lowest cost but give an optimum profit, which
will avoid misspend money.
It also to recognize and list down all the materials needed to effort by making
some arrangement for the quantity and quality of material needed and recognized
supplier.

36

4.1 FLOW CHART OF OPERATION ACTIVITIES


It is schematic representation of the operation process from the start until the end.
Ready of broiler closed house

Install the necessary brooding equipment

Received a day-old-chick (DOC)

Keep DOC in broiler close house

Check the chick quality

Daily control and quality control

Waiting for a growing process

Catching process

Distributor takes back the chicken

Disinfection process

37

FLOW CHART CONVENTIONAL SYMBOLS

SYMBOL

ACTIVITY

DESCRIPTION

Material are being


OPERATION

processed of planning and


calculating

Received and return the


TRANSPORTATION

chicken to the supplier and


delivered it to the customer
Inspection on the size,
weight, quality of the

INSPECTION

chicken we ordered and


delivered

DELAY

Waiting a growing process

Material and property are


STORAGE

stored in the storage

38

PROCESS FLOW CHART


1) Ready of broiler closed house

2) Install the necessary brooding equipment

3) Received a day-old-chick (DOC)

4) Keep DOC in broiler close house

5) Check the chick quality

6) Daily control and quality control

7) Waiting for a growing process

8) Catching process

9) Distributor takes back the chicken

10) Disinfection process

39

4.2 OPERATIONS SYSTEM


1) Ready of broiler closed house.
Our breeding project of day-old-chick required our company to build pens on
2.273 acres. Before we have building and

planning construction of a boiler house,

firstly we select a site that is on well-drained land and has plenty of natural air
movement. The house should be oriented on an east-west axis to reduce the amount of
direct sunlight on the sidewalls during the hottest part of the day. The house is singlestorey and has a wide of 350 feet x 40 feet x 7 feet. The design is such that chickens
are not exposed to injury. This is close house system, so there is an alarm signal.
These alarm signals are useful to give a warning during a blackout. Then the
generator will be used to provide a power electric.

40

2) Install the necessary brooding equipment

a) Drinker System
This system providing clean, cool water with adequate flow rate is
fundamental to good poultry production. Without adequate water intake, feed
consumption will decline and bird performance will be compromised. Our company
has used closed systems {nipple systems).The nipple drinkers operate at a flow rate of
50 to 60 ml/min. The pressure is adjusted to maintain water flow to meet the broiler's
water needs and to adjust it, we use regulator. Nipple drinkers will be adjusted to suit
chick height and water pressure. It must have evenly distributed pressure optimized
for output without contributing to excessive dripping.

41

b) Feeding System
Our company has used auto pan feeding system. This system is allowing for
unrestricted bird movement throughtout the house, has a lower incidence of feed
spillage, and improved feed conversion. In addition, pan feeders fill simultaneously
minimizing bird competition when the feed lines are charged. Automated chain
feeders allow for a minimum of 2.5 cm (lin) feeder space per bird. The maintenance
of feed track, corners, and chain tension is essential. If the height is not adjusted
properly, it can restrict bird movement within the house. The feed depth is controlled
by feed slides in the hoppers and will be closely monitored to prevent feed wastage.

L-

42

c) Pad Cooling System


We have to monitor level of ammonia, carbon monoxide, carbon dioxide,
hydrogen sulfide and oxygen. In closed house system from time to time to ensure it
does not affect health of chickens and workers. When the thermostats or probes
detects the temperature below 30C the water will be automatically flow out from the
front of the pens. The machine is calling the pad cooling system. Then the exhaust fan
will pull out any gases and air that are not at the good level. The suitable temperature
is according to stage of growth.

43

3) Chick Placement
We buy a chick from our head company, Pertanian Pertiwi. This day-old-chick
will be sending to us more than 18000 of chicks. These chicks are from same flock or
same age. The delay in placement can contribute to the dehydration of chicks,
resulting in higher chick mortality and reduced growth rate. Chick must be carefully
placed and evenly distributed near feed and water throughout the brooding area. The
light will be brought to full intensity within the brooding area once all chicks have
been placed. We have to monitor the distribution of the chicks closely during the first
few days. This can be used as an indicator for any problems in feeder, drinker,
ventilation or heating systems.

4) Chick Quality
Two hours after chick placement, we will be checking their quality. This is to
ensure they are comfortable with the temperature. Chicks too warm will try to move
away from heat, will be panting, will appear quiet and their wings may drop. Chicks
too cold will crowds towards the heat, will huddle in groups and be noisy. While,
chicks at the correct temperature will be evenly spread, show varied behavior (eating,
drinking, resting and interacting) and will be softly chirping. Characteristics of a good
quality chick are well dried, long fluffed down, bright round active eyes, look active
and alert, have completely healed navels, free of red hocks and should be free from
deformities.

44

5) Daily Control and Quality Control

a) Ventilation
In order to the proper temperature, ventilation needs to be considered.
Ventilation distributes heat throughout the house and maintains good air quality in the
brooding area. We have to monitor level of ammonia, carbon monoxide, carbon
dioxide, hydrogen sulfide and oxygen. In closed house system from time to time to
ensure it does not affect health of chickens and workers. When the temperature
transducer detects the temperature below 30C the water will be automatically flow
out from the front of the house. The machine is calling the cooling pad system. Then
the exhaust fan will pull out any gases and air that are not at the good level. The
suitable temperature is according to stage of growth

Description

Weekl

Week 2

Week3

Week4

Week5

Temperature

33C

32C

29C

29C

29C

Air speed

<50 ft/min

100 ft/min

200 ft/min

300 ft/min

400-500 ft/min

Thermostat

34C

32C

30C

30C

30C

Exhaust Fan

45

b) Feed and Water


Our broiler management is always making sure that both the feeders and
drinkers are in adequate supply relative to the stocking density and are approximately
placed. The nipple drinkers would be at chicks' eye level for the first 2 to 3 days of
age and then maintained slightly above chicks' head. Pressure would be such that
there is a droplet of water suspended from the nipple but no leakage. The birds' feet
are always being flat on the litter and a bird will never have to stand on its toes to
drink. Feed are provides in crumb form and placed on trays. Feeders will be raised
incrementally throughout the growing period so that the pan is level with the bird's
hack at all times. The feed level within the feeders will be set so that feed is readily
ivailable while spillage is minimized.

46

c) Light
Light intensity will be minimum of 20 lux (2 foot candles) in the darkness
place in the brooding area during the brooding phase. Light intensity, distribution,
color and duration affect the performance and welfare of the flock. Proper light
placement and distribution will encourage chicks to find feed, water and warmth
during the brooding phase.

d) Disease Control
The veterinary will come every week to monitor disease status in house on a
schedule basis. The culled chicken will be separate before its spread. The antibiotic or
vaccine will be put in water. The use of the correct medication and the timing of
treatment can be crucial in combating a disease problem. The preferred choice of a
drug or antibiotic for some disease may be harmful if used for the treatment of others.

e) Bio-security
Bio-security is the term used to describe an overall strategy or succession of
measures employed to exclude infectious diseases from a production site. Outlined
below are the key points that make us successful in bio-security program.
> Keep door and gate lock at all times.
> Farms are fenced.
> No pet animal that are allowed in or around poultry housing.
> Limit non-essential visitors to the farm.
> If equipment must come from another farm, it would be thoroughly
cleaned and disinfected before it comes onto the farm.
> Farms have a toilet and hand washing facilities separate from the
poultry house.

47

6) Growing Phase
a) Uniformity
Uniformity is measure of the variability of bird size in a flock. The coefficient
of variation (CV) is commonly used to describe variability within a population. A low
CV indicates a uniform flock whereas a high CV indicates an uneven flock.

Coefficient of Variation
CV% = standard deviation

To estimate the CV of a flock, we will divide the house into three sections. A
random sample of approximately 100 birds from each section, or 1% of the total
population will be weighed and the individual weights recorded. It is important to
weigh all birds within the catch pen excluding culls. Birds will be weighed daily for
the first two weeks of age and weekly thereafter.

Flock Uniformity

CV

Uniformity

Evaluation

80%

Uniform

10

70%

Average

12

60%

Poor uniformity

b) Modification of Feed and Nutrient Intake


Adjusting dietary nutrient density or the physical form of the feed (mash vs.
pellet) will influence broiler growth rates. Lower nutrient density diets may have a
negative impact on feed conversion and yield but will cost less to produce. An
analysis of dietary cost versus bird performance is essential in determining the best
option.

48

c) Lighting Programs
Lighting programs are a key factor in proper broiler management and are
fundamental to optimal performance. Lighting programs are typically designed with
changes occurring at predetermined ages and tend to vary according to the final target
market weight of the broilers.
Description

Light

Weekl

Week 2

Week 3

23 hours

20 hours

18 hours

||

0600

gj 0300 till g} 0100 till


morning

Week 4

Week5

Natural sun light

morning

7) Catching Process
Feed withdrawal will take place 8 to 12 hours before processing to reduce
carcass contamination. The purpose of feed withdrawal is to empty the digestive tract,
preventing ingesta and /or fecal material from contaminating the carcasses during the
evisceration process. When birds are fasted between 8 and 12 hours, the intestine is
almost completely empty yet strong enough to withstand the evisceration process
without rupturing.

Preparation for catching


> Water must be available until the start of catching
^ Lighting will be dimmed at the time of catching. If dimming is not
feasible, the use of blue or green bulbs will clam birds and reduce
activity.
> Remove or raise all equipment that may interfere with the catch crew.
> Careful management of the ventilation system is needed during
catching to ensure adequate house ventilation.

49

Dark strip curtains hung over the doors block out light during daytime
catching. These allow birds to remain quiet and will facilitate better ventilation.
Lightweight curtains can be used to partition the house into smaller pens. This can
reduce bird stress and diminish the risk of piling. Birds will be carefully placed in
clean crates or modules.

8) Disinfection
House will be disinfected thoroughly after every production cycle and left
empty for a suitable period of time (can stop breeding cycle of disease carrier) before
a new flock is brought in. Normally about 2 week. All farm equipment disinfected
thoroughly after use and kept in a clean and dry place.

43 BUSINESS OPERATION TIME

Our business operation starts from 9.30 am - 5.30 pm. We picked this time as
it is the appropriate time for any company / business to start and close their business
daily. In the daytime, chicken will be cared and well kept by our experienced workers
to make sure the safety and health of the birds. At night, they are allowed to roam and
wander in the farm but adequate food and water are still provided. They are the most
convenient animal to breed.

Operation time:
Monday - Friday

: 9.30 am - 5.30 pm

Saturday - Sunday : 10.30 am - 4.30 pm

Our operations include the process of feeding, health care and breeding.

50

4.4 CAPACITY PLANNING

Below are the lists for cost of raw material per chicken:
Raw Material
i.

Cost per chicken (RM)

Day Old Chicks

1.05

Starter Feed

0.60

iii.

Pre-Grower Feed

1.38

iv.

Grower Feed

1.32

v.

Finisher Feed

1.25

vi.

Vaccine and Medication

0.20

11.

5.80

Total
Average weight of a big chicken is 2.3 kg,

Total of raw material per chicken's weight = RM 5.80 / 2.3 kg


= RM 2.52

COST OF RAW
MONTH

NO OF UNIT

MATERIAL PER

(kg)

CHICKEN

AMOUNT (RM)

(RM/kg)
January-February

41,400

2.52

104,328

March-April

41,400

2.52

104,328

May-Jun

41,400

2.52

104,328

July-August

41,400

2.52

104,328

September-October

41,400

2.52

104,328

November-December

41,400

2.52

104,328

TOTAL YEAR 1

248,400

2.52

625,968

TOTAL YEAR 2

248,400

2.52

625,968

TOTAL YEAR 3

250,500

2.52

631,260

51

4.5 TOTAL COST


MONTH

AMOUNT

January-February

104,328

March-April

104,328

May-Jun

104,328

July-August

104,328

September-October

104,328

November-December

104,328

TOTAL

625,968

4.6 MATERIAL REQUIREMENTS (INPUT)

The following are the input of the operation process.

Raw Material

Cost per chicken (RM)

i.

Day Old Chicks

1.05

ii.

Starter Feed

0.60

iii.

Pre-Grower Feed

1.38

iv.

Grower Feed

1.32

V.

Finisher Feed

1.25

Vaccine and Medication

0.20

vi.
TotalI

5.80

52

4.7 LIST OF OPERATIONS PERSONNEL

POSITOIN

NO. OF PERSONNEL

Operation Manager

Farm Workers

4.8 SCHEDULE OF TASKS AND RESPONSIBILITIES

POSITION

RESPONSIBILITY/DUTY
> Gives a good co-operation as to
maintain the smoothness of the
operation
> To make sure the entire auto pan
feeding system, nipple drinking
system, brooding system and
control system are in good

Farm Workers

condition.
> To make an immediate report on
machine, equipment or other
damages.
> Gives a food or other daily routine
at the applicable time.
> Always obey the rules that fixed
by company.

53

4.9 SCHEDULE OF REMUNERATION

POSITION

NO.

MONTHLY

EPF 12%

socso

SALARY

(RM)

2.5%

(RM)

Operation

TOTAL

(RM)

1,300

156

33

1,489

500(each)

120

25

1,145

2^00

276

58

2,634

Manager

Farm
Worker

TOTAL

54

4.10 MACHINE AND EQUIPMENT

a) Infrastructure Development

Cost (RM)

6,000

i.

Construction of access road

ii.

Land clearing

10,000

iii.

Fencing

15,000

iv.

Main Drain System

8,000
39,000

TOTAL

b) Equipment and Machinery

TOTALCOST
ITEM
1

TYPES

NO.

PAD COOLING SYSTEM

1.1

50" fan 1.0 hp 380 V with auto shutter

1.2

Cooling Pad 6"x 24"x 60"

80

1.3

5'xl0' S.S Frame for Cooling Pad

1.4

Water tank with capacity of 150 gallon

1.5

Install connection of water pipe

1.6

Water pump 1.0 hp

Total for item no. 1


2

(RM)

28,000

BOTH SIDE CURTAIN


Total for item no.2

6,200

55

AUTO PAN FEEDING SYSTEM

3.1

Feed Hopper

3.2

336' steel pipe complete with plastic pan and

0.5 hp motor
3.3

Hand winch

3.4

Height adjusted of the auto pan feeding

system-336'
3.5

1 Gallon Drinker for day-old-chick

200

3.6

Square chick tray for day-old-chick

200
23,000

Total for item no.3


4

NIPPLE DRINKING SYSTEM

4.1

Regulator

4.2

Nipple water PVC pipe and aluminum bar

340' long.
4.3

Hand winch

4.4

Height adjusted

4
of the nipple drinking

system-336'
14,600

Total for item no. 4


5
5.1

BROODING SYSTEM
Brooder gas

15
4,200

Total for item no. 5


6

CONTROL SYSTEM

6.1

Control system for 50" exhaust fan

6.2

Control system for water pump

6.3

Control system for Pan Feeding

1
8,000

Total for item no. 6


7

ELECTRICAL SUPPLY

7.1

Sub-board

7.2

Lamp

50

7.3

Lamp post

56

7.4

Electrical wiring for lamp, fan and water


pump in broiler closed house.
12,000

Total item for no.7


8

GENERATOR

8.1

1 unit Gen-Set

Total for item no. 8


9
9.1

10,000

WATER SUPPLY
1 unit water tank

1
5,000

Total for item no.9


10

Others

10.1

Trolley

10.2

Safety gear and tooling


TOTAL FOR ALL ITEM

200
2,000
113,200

Therefore the total costs are;


Cost of Infrastructure Development + Cost of Equipment and Machinery
= RM 39,000 + RM 113,200
= RM 152,200

57

4.11 OPERATIONS SPACE LAYOUT PLAN (BROILER CLOSED HOUSE)

o
o

KEYS

Feed Hopper

Storage and Control Room

[]

0.5 HP Motor

Auto Pan Feeding Lines

Regulator

Nipple Line

50" Exhaust Fan

Plastic pan

Water tank

Cooling Pad
58

4.12 OPERATION OVERHEAD

Below are the lists of estimated broiler production cost for overhead expenses:
Types

Cost per chicken (RM)

i.

Electricity

0.20

ii.

Water

0.08

iii.

Wood Shaving

0.08

iv.

Catching Crew

0.15

v.

Gas for brooding

0.08

Total

0.59

Total costs for operation overhead are:


= RM 0.59 X 18,000 chickens + Maintenance of Machinery + Miscellaneous
= RM 10,620+RM 250 +RM 200
= RM 11,070

NO.

ITEM

AMOUNT PER MONTH


(RM)

UTILITY

5,040

1.1 Water
1.2 Electricity
2

MAINTENANCE OF MACHINERY

TOOLS AND DYES

250
2,880

3.1 Wood shaving


3.2 Gas for Brooding
4

PARTIME WORKER (3 catching crew)

MISSELLANEOUS
TOTAL

2,700
200
11,070

59

4.13 OPERATION BUDGET

FIXED
PARTICULARS

ASSET

MONTHLY

OTHER

COST

EXPENSES

EXPENSES

(RM)

(RM)

(RM)

TOTAL

Fixed Asset
> Equipment and

113,200

113,200

39,000

39,000

Machinery
>

Infrastructure
Development

Working Capital
> Purchase of

104,328

104,328

1,145

1,145

11,070

11,070

Material
> Salaries,
EPFand
SOCSO
> Operation
Overhead
Other Requirements
> Deposit

5,000

5,000

> Other

2,500

2,500

7,500

276,243

Expenses
TOTAL

152,200

116,543

60

61

5.0 INTRODUCTION

The most crucial before starting a new business is how to get the capital and
how the capital will be use. Financial system is basic thing or features in a business
and it is the main source to control the journey of a business.
A complete set of account which is related with the organization journey will be
prepared by the chosen Financial Manager; to financial statement every year. It will
show the profit or loss of our company, assets, liabilities and the stability and growth
of our company's financial to make it faster. Besides, financial system can give us
clear picture about return of capital that will be gain or capital investment that has
been done.
The information of financial plan is gathered on the input from the
"ministrative budget, marketing budget and operation budget.
In the financial, we have prepared the working paper, schedule and financial
itement. The statements are:

> Project cost schedule of the project


> Sources of financial
> Schedule of loan repayment
> Schedule of hire purchase
> Schedule of fixed assets depreciation
> Cash flow pro-forma
> Profit and loss pro-forma
> Balance sheet pro-forma

62

OBJECTIVE
The objective of financial plan is;
> To determine the amount of money to be invested that is the project cost.
> To identified and propose the relevant source fund
> To ensure that the initial capital is sufficient
> As a guideline for implementation
> To know whether the business is competitive or not
^ To determine the potential of the business to generate profit
> Cash outflows and cash inflows in the business project
> Hire purchase installment payment
> Loan installment payment
> Depreciation on the fixed assets
> The company's capital structure
> The total cost that we need to start the business
> Cost or paid up capital involves for starting the business

63

5.1 PROJECT IMPLEMENTATION COST SCHEDULE

RM
Capital Expenditures/Investment in Fixed Asset
Land & Building
Furniture
Office and Equipments
Infrastructure Development
Sign Board
Machinery
Total

13 8,000
2,180
6,670
39,000
500
113.200
299,550

Working Capital/Monthly Expenses (for 2 month)


Administrative
Marketing
Operation
Day-old-chick (DOC)
Total

14,128
400
24,430
18.900
57,858

Other Expenses
Deposit
Company Registration & license Fees
Other Expenses for operation
Business Card

Total
Contingencies (2%)
TOTAL

5,000
100
2,500
100
7,700
7,302
372,410

64

5.2 SOURCE OF FINANCE SCHEDULE

Equity Contributions

RM

RM

Partners Contribution:
Mohamad Shukry bin Maksah

34,910.00

Muhammad Fairuz bin Johari

15,000.00

Muhd Nurfaiz bin Baharuddin

15,000.00

Ahmad Luqman bin Mahammed Shaihani

15,000.00

Sub-Total

79,910.00

External Sources
Bank Loan
Existing asset

290,000.00
2,500.00

Sub-Total

292,500.00

TOTAL SOURCES OF FINANCE

372,410.00

65

5 3 SUPPORTING SCHEDULES

LOAN OF AMORTIZATION SCHEDULE

Total Loans: RM 290,000.00


Interest rate: 4 %
Duration

: 4 years / 48 months

Method

: Flat Rate Method

YEAR
1
2
3
4
5
6
7

PRINCIPAL

INTEREST

TOTAL
REPAYMENT

BALANCE

72,500

11,600

84,100

217,500

72,500

11,600

84,100

145,000

72,500

11,600

84,100

72,500

72,500

11,600

84,100

66

FIXED ASSET DEPRECIATION SCHEDULE

Type of Asset : Furniture


Actual Price

: RM 2,180.00

Economic Life: 5 years


Method

Year

1
2
3
4
5

: Straight Line Method

Yearly Depreciation

Total Depreciation
(RM)

Balance
(RM)

436

436

RM 1,744.00

436

872

RM 1,308.00

436

1,308

RM 872.00

436

1,744

RM 436.00

436

2,180

67

Type of Asset : Equipment


Actual Price

: RM 6,670.00

Economic Life: 5 years


Method

: Straight Line Method

Year

Yearly Depreciation

Total Depreciation
(RM)

RM 1,334.00

1,334.00

5,336.00

RM 1,334.00

2,668.00

4,002.00

RM 1,334.00

4,002.00

2,668.00

RM 1,334.00

5,336.00

1,334.00

RM 1,334.00

6,670.00

Balance
(RM)

68

Type of Asset : Signboard


Actual Price

: RM 500.00

Economic Life: 5 years


Method

: Straight Line Method

Year

Yearly Depreciation

RM 100.00

Total Depreciation
(RM)

Balance
(RM)

RM 100.00

RM 400.00

RM 100.00

RM 200.00

RM 300.00

RM 100.00

RM 300.00

RM 200.00

RM 100.00

RM 400.00

RM100 .00

RM 100.00

RM 500.00

69

Type of Asset : Machinery


Actual Price

: RM 113,200

Economic Life: 5 years


Method

: Straight Line Method

Year

Yearly Depreciation

Total Depreciation
<RM)

RM 22,640.00

RM 22,640.00

RM 22,640.00

RM 45,280.00

RM 67,920.00

RM 22,640.00

RM67,920.00

RM 45280.00

RM 22,640.00

RM90,560.00

RM 22,640.00

RM 22,640.00

RM113,200.00

Balance
(RM)
RM 90,560.00

70

Type of Asset : Infrastructure Development


Actual Price

: RM 39,000

Economic Life: 5 years


Method

: Straight Line Method

Year

Yearly Depreciatioii

Total Depreciatioii
(RM)

RM 7,800.00

RM 7,800.00

RM 7,800.00

RM 15,600.00

RM 23,400.00

RM 7,800.00

RM23,400.00

RM 15,600.00

RM 7,800.00

RMS 1,200.00

RM 7,800.00

RM 7,800.00

RM39,000.00

Balance
(RM)
RM 31,200.00

71

5.4 PROFORMA FINANCIAL STATEMENTS


CASH FLOW PROFORMA (ANUALLY)
Yearl
(2006)

YEAR 2
(2007)

YEAR 3
(2008)

79,910.00
290,000.00
394,496.00
361,560.00

394,496.00
394,557.00

406,725.00
405,706.00

Total Cash Inflows

1,125,966

789,053.00

812,431.00

Cash Outflows
Administrative
Expenditure:
Salary, EPF, SOCSO
Stationary
Miscellaneous
Telephone

76,968.00
600.00
1,200.00
6,000.00

76,968.00
600.00
1,200.00
6,000.00

76,968.00
600.00
1,200.00
6,000.00

Marketing
Expenditure:
Salary, EPF, SOCSO
Miscellaneous

2,400.00

2,400.00

2,400.00

Operational
Expenditure:
Cash Purchases
Salaries, EPF,SOCSO
Operation Overhead

113,400.00
13,740.00
132,480.00

113,400.00
13,740.00
132,480.00

113,400.00
13,740.00
495,960.00

5,000.00
100.00

_
-

_
-

2,600.00
138,000.00

2,600.00
-

2,600.00
-

159,050 .00

Cash Inflows
Owners' Capital(cash)
Bank Loan
Sales
Collection of
Accounts Receivable

Deposit
Registration &
Licenses
Other Expenses
Purchase of Fixed
Assets - Land &
Building
Purchase of Fixed
Assets - Others

72

Loan Payment
Principle
Interest

72,500.00
11,600.00

72,500.00
11,600.00

72,500.00
11,600.00

Total Cash Outflows

735,998.00

433,848 .00

776,668 .00

EXCESS/(DEFICIT)

389,968.00

355,205.00

378,583.00

389,968.00

745,173.00

745,173 .00

1,123,756.00

Opening Cash
Balance
Ending Cash
Balance

389,968.00

73

PROFORMA PROFIT AND LOSS ACCOUNT


FRESH CHICKEN FARM
Proforma Profit and Loss Account for the Year Ending 31 Dec 2006
RM
RM
Sales

788,992
Less: Cost of Goods Sold
Opening Stock Purchases
Gross Profit
Less Expense:
Administration Expenses:
Salary, EPF, SOCSO
Stationary
Miscellaneous
Telephone
Marketing Expenses:
Salary, EPF, SOCSO
Miscellaneous
Operation Expenses:
Salaries, EPF & SOCSO
Operation Overhead
Financial Expenses:
Interest on Loan
Depreciation on Fixed Assets
Registration & Licenses
Other Expenses

113,400

76,968
600
1,200
6,000

2,400
13,740
132,840
11,600
32,310
100
2,600

Total Expenses

393,758

Net Profit before Taxes


Net Profit after Taxes
Accumulated Net Profit

395,234
395,234
395,234

74

PROFORMA BALANCE SHEET ACCOUNT


FRESH CHICKEN FARM
Proforma Balance Sheet for the Year Ending 31 Dec 2006
RM

Fixed Asset
Land & Building
Furniture
Equipments
Signboard
Machinery
Infrastructure Development
Total Fixed Asset

138,000
1,744

5,336
400
90,560
31.200
267,240

Current Asset
Deposit
Accounts Receivable
Cash
Total Current Asset

5,000
32,936
389.968
427,904

Total Asset

695,144

Owner Equity
Capital (Owner's Equity)
Accumulated Profit
Total Equity

477,644

Liabilities
Loans balance
Total Liabilities

217,500

TOTAL EQUITY AND LIABILITIES

82,410
395.234

217.500

695,144

75

Fi

Oil

76

CONCLUSION

Based on the business plan that has been done, we have not only shown the financial
performance of this business but also the capability of the business. Because this kind
of business is rather new, our company is confident that we can penetrate the market
share.

From our observation, we also found that the Malaysian's stable economic situation
and the Malaysian's fondness to try new type of food especially Chinese will help to
encourage our business to grow. Adding to the fact that chicken's meat is lower in
cholesterol that any other meat found in the market, we are also confident that this
will also attract the health-conscious people to try this new alternative food.

The organization team for FRESH CHICKEN FARM consists of 4 dedicated,


disciplined and motivated individuals with the same aim of strengthening the
company.

As a conclusion, we strongly believe that FRESH CHICKEN FARM has a potential


in running this business and has the competitive edge to succeed.

77

,\

I)

78

The environment of location before the project being proceeds

4- The location under construction.

4- Our products.

Mohammad Shukry B. Maksah


No. 41, Jalan Sri Damak 50,
Taman Sri Andalas,
41200 Klang
Selngor

To Whom It May Concern.

Dear Sir,

Agreement on using land at Lorong Sarkawi, Jalan Kebun, Klang Selangor.

I am, Siti Bt Hj. Abdul Rahman as the owner of the land located above, agree to let
my niece to develop that unoccupied land to open a broiler house with some
incentives as in return. I will not be accused if they had a problem or involved in
problem.

Thank You,

Your Faithfully

SitiBtHj. Rahman
(No. VC: 4297581)

October 2, 2005
FRESH CHICKEN FARM
Lot 3307, Batu 7, Lorong Sarkawi,
Jalan Kebun,
42450, Klang
Selangor Darul Ehsan.

Dear FRESH CHICKEN FARM,

Contract Farming With FRESH CHICKEN FARM At Jalan Kebun, Klang,


Selangor

We are please to inform you that we have accepted your proposal to rear 18,000 birds/ flocks about 1 house
on a piece of land specifies above with the concept of new broiler closed house.
You will have to construct the chicken's house according to Pertanian Pertiwi Sdn. Bhd. Specifications and
will sign a Contract Farming Agreement with Pertanian Pertiwi when the construction of the chicken house
is completed.
The company will then supply you day-old-chicks and feed according to the agreement that will be signed
when you have complete construct your chicken house. We will market all the birds when they reach market
size.

Thank you.

Yours faithfully,
Mr. Liau Chai Peng
Branch IManager(Klang)
Pertanian Pertiwi Sdn. Bhd.

IM -REGISTER,
Enactment.

(I.an.1 )0)

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.i).nhlnl yai ? di-peilmat Ahhir-nya
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Peratur-peraiuran yaug

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| SIDE VIEW

TP 69A

{TELEKOM
^SSK

MALAYSIA

Rujukan
PERMOHONAN UNTUK PERKHIDMATAN PERNIAGAAN
(Telefon-Datel-Teleteks-Tetefax-Teleks)

NAMAPENUH

Untuk Kegunaan
Pejabat Sahaja

I ' 1

(Seperti dim K/Pengenalan/Paspot/Sljil Daftar Perniagaan)


Jika perkhidmatan adalah di bawah nama Peiniagaan/Kerajaan/Kedutaan,
dll., nyatakan Nama Pengguna dan Pangkat.
NAMAPENUH
PENGGUNA

I 1

1 1 1 1

Kod Kategon
Pelanggan

1 I

1 I

PANGKAT

II

No. Kad Pengenalan

No. Pendaftaran
Perniagaan

No. Paspot

Kod Negara

Negara

1 I
Tingkat

ALAMAT PERSURATAN : No.

No Lot/No. Pangsapuri :

I 1
II

Nama Jalan :

Tmn./Seksyen :

L_J

Peti Surat :

Bandar :

Bangunan

I
I

I
I

. I

I_J

Poskod :

I I

Negen :

LJ L
I

I 1 1 I l
I

A L A M A T PEMASANGAN (Jika berlainan daripada alamat persuratnn) '

No. I

Tingkat

I!

Bangunan :

Tmn./Seksyen ;

1 _L_ J

Poskod :

TANDAKAN

II

Nama Jalan :

Bandar :

No. Lot/No. Pangsapuri :

II

I
I

II

J I

I
I

J
) DALAM KOTAK

|.J
'

LJ

<i BERKENAAN

Negeri :

I
Lihat Sebelah

PERKHIDMATAIM DIPERLUKAPJ

ATD (ISO)

TALIAN IBUSAWATTERUS

SAMBUNGAN SELARI

RAOAS TELEFON TAMBAHAN

Bil Talian
Oikehendaki

PERKHIDMATAN

Jems/Model
Bil Nombor
Utama

Bil
Sambungan

P ABX

KEY
TELEFON

Bil
Stesen

Bil. Norpbor
Auxiliary

PERKHIDMATAN TELEMATIC

Jems/Model
Radas

PERKHIDMATAN

Jems/Model
Modem

Catatan "

DATEL
TELETEKS
TELEFAX

Menggunakan Nombor Telefon yang sediada

Jems Radas

PERKHIDMATAN

I"

Cadangan Kod Jawab-Balik

TELEKS

KEMUDAHAN TAMBAHAN/CIRI-CIRI KHAS DIKEHENDAKI .

CATATAN

Tahun

Bulan

Han

Tandatangan Pemohqn

TANDAKAN ( ^

) DALAM KOTAK YANG BERKENAAN

Jika menggunakan radas sendirf, sila kemukakan surat pembekal. Cuma radas Kelulusan STM/JTM (Kswasolia) boleh digunakan.

PNA. 42
PEJA&AT PENDAFTAR PERNIAGAAN
Permohonan Kelulusan Nama Perniagaan
(Tiada Bayaran Dikenakan)

Saya memohon menggunakan salah satu nama-nama perniagaan dibawah:


(a)
(b)
(c)
* Nama dan Alamat Pemiiik / Pekongsi

* No. Kad Pengenalan & Wama

((.junakan lampiran lamjika pemiiik lebih 3 orang)

(a)Nama:
Alamat:

Baru: .
Lama:

(b)Nama :

Baru:

Alamat:

Lama:

(c)Nama :

Baru:

Alamat:

Lama:

* Jenis perniagaan dijalankan :

# Tarikh

* Tandatangan Pemohon :
Nama

No. K/P :
# No. Rujukan:
# No. Rujukan:

# Catatan :

Tarikh:
(

Penolong Pendaftar Perniagaan


+ Sila lihat syarat kelulusan dimuka sebelah.
* Pemohon hendaklah melengkapkan ruangan-ruangan ini.
# Ruangan ini dibiar kosong.

Kuala Lumpur

Syarat-syarat Kelulusan
1.

Permohonan nama perniagaan yang tidak meraenuhi syarat di bawah akan ditolak:
a.
b.
c.
d.
e.

Nama perniagaan tidak bersesuaian dengan jenis perniagaan yang dijalankan.


Nama yang dipohon telah digunakan oleh peniaga lain.
Menggunakan nama diri yang bukan nama sebenar pemilik.
Menggunakan perkataan yang dikawal oleh Pendaftar.
Nama yang tertakluk di bawah Kaedah Pendaftaran Perniagaan 1957.

2.

Nama yang diluluskan tidak boleh dipinda/ditambah perkataan atau huruf.

3.

Kelulusan ini tidak boleh dipindah milik kepada orang lain.

4.

Permohonan baru perlu dibuat jika perniagaan tidak didaftarkan selepas tamat tempoh kelulusan
nama perniagaan.

5.

Permohonan yang mempunyai perniagaan lain yang telah tamat tempoh laku Sijil Perakuan
Pendaftarannya hendaklah memperbaharui Sijil Perakuan itu dahulu atau memfailkan Borang ' C .

6.

Pemilik/Pekongsi mestilah bermastautin di negeri di mana perniagaan dijalankan.

KELULUSAN INI MENJADI BATAL JIKA SATU ATAU SEMUA SYARAT DI ATAS TIDAK
DIPATUHI.

KAEDAH-KAEDAH PENDAFTARAN
PERNIAGAAN 1957
(KAEDAH 3)

PENDAFTARAN PERNIAGAAN

UNTUK KEGUNAAN PEJABAT


NO.PERAKUAN

BORANG
A
DIBIARKAN KOSONG

f>ENDAFTARAN PERNIAGAAN,

Saya/Kami yang bertanggungjawab menyerahkan butir-butir berikut mengenai perniagaan yang tersebut di bawah mi
untuk didaftarkan.
Saya/Kami menyerahkan Wang Kiriman/Wang Tunai sebanyak RM25/RM50 untuk bayaran pendaftaran dan untuk
^erakuan Pendaftaran.
A. MAKLUMAT PERNIAGAAN
1. NAMA PERNIAGAAN

2. TARIKH MULA BERNIAGA

3. PERJANJIAN PERKONGSIAN (PILIH SATU)


ADA (LAMPIRKAN SURAT PERJANJIAN)
TARIKH
TIADA

4. ALAMAT TEMPAT UTAMA/PENGKALAN PERNIAGAAN

4.1. BANDAR

4.2. POSKOD

4.3. NEGERI (KOD)

5.2. POSKOD

5.3. NEGERI (KOD)

.5. ALAMAT SURAT-MENYURAT (JIKA BERLAINAN DARI DI ATAS)

15.1. BANDAR

KAEDAH-KAEDAH PENDAFTARAN
PERNIAGAAN 1957
(KAEDAH 3)

PENDAFTARAN PERNIAGAAN

B. MAKLUMAT'CAWANGAN
UNTUK KEGUNAAN PEJABAT
NO PERAKUAN

BORANG
A
DIBIARKAN KOSONG
ALAMAT CAWANGAN

1. BANDAR

1.2. POSKOD

1.3. NEGERI(KOD)

1.2. POSKOD

1.3. NEGERI(KOD)

1.2. POSKOD

1.3. NEGERI(KOD)

ALAMAT CAWANGAN

.1. BANDAR

ALAMAT CAWANGAN

.1. BANDAR

KAEDAH-KAEDAH PENDAFTARAN
PERNIAGAAN 1957
(KAEDAH 3)

PENDAFTARAN PERNIAGAAN

C. IVIAKLUMAT PEMILIK
UNTUK KEGUNAAN PEJABAT
NO. PERAKUAN

Nota: Tiap-tiap pemilik hendaklah mengisi


butir-butir bahagian ini dalam
helaian berasingan.

BORANG

DIBIARKAN KOSONG
1. NAMA PEMILIK

2. JANTINA
LELAKI
PEREMPUAN

3. NO. PENGENALAN DIRI


KAD PENGENALAN
(BARU)

PASPORT

POLIS

TENTERA

KAD PENGENALAN (LAMA)

4. WARNA
BIRU

5. TARIKH LAHIR
MERAH

LAIN-LAIN

6. ALAMAT KEDIAMAN

6.1. BANDAR

7. BANGSA

6.2. POSKOD

6. KERAKYATAN

6.3. NEGERI (KOD)

9. PEMILIKAN

MELAYU

MALAYSIA

KETUANPUNYAAN
TUNGGAL

CINA

PENDUDUK TETAP
(NYATAKAN NEGARA ASAL)

KONGSI UTAMA

INDIA

KONGSI BIASA

BUMIPUTERA SABAH
10. TANDATANGAN PEMILIK
BUMIPUTERA SARAWAK

LAIN-LAIN
(SILA NYATAKAN)

PENDAFTARAN PERNIAGAAN

KAEDAH-KAEDAH PENDAFTARAN
PERNIAGAAN 1957
(KAEDAH 3)
t). MAKLUMAT JENIS PERNIAGAAN
UNTUK KEGUNAAN PEJABAT
NO. PERAKUAN

UNTUK KEGUNAAN PEJABAT


KOD JENIS PERNIAQAAN

BORANG

A
DIBIARKAN KOSONG

I. JENIS PERNIAGAAN

2. TARIKH

DIBIARKAN KOSONG

KAEDAH-KAEDAH PENDAFTARAN
PERNIAGAAN 1957
(KAEDAH 3)

PENDAFTARAN PERNIAGAAN

E. PENGESAHAN OLEH SEKUTU-NIAGA


UNTUK KEGUNAAN PEJABAT
NO. PERAKUAN

BORANG
A
DIBIARKAN KOSONG

Saya/Kami yang bertandatangan di bawah ini mengesahkan bahawa segala kenyataan yang dibuat dalam borang ini
adalah tepat dan mengaku bahawa saya/kami adalah sekutu dalam perniagaan bernama

NAMA PENUH

NO. KAD PENGENALAN/WARNA

TANDATANGAN/CAP IBU JARI KANAN

Saya mengaku bahawa tandatangan/cap ibu jari kanan di atas telah diturunkan pada akuan di atas ini di hadapan
saya setelah saya berpuashati bahawa orang yang menurunkan tandatangan/cap ibu jari kanan itu adalah sebenarnya
Drang yang namanya tersebut dalam akuan itu dan ia/mereka faham maksud akuan itu.

Bertarikh di.

.pada.

.haribulan

. tahun.

NAMA :
JAWATAN :
ALAMAT :
(TANOATANGAN DAN COP RASMI
PEGAWAI PENGESAH)

Catatan: Pengesahan di atas hendaklah disaksikan oleh - Ahli Parlimen atau Ahli Dewan Undangan
Negeri, Hakim, Majistret, Pegawai Kumpulan Pengurusan dan Profesional, Peguambela atau
Peguamcara, Penghulu, Penggawa, Jaksa Pendamai (J.P), atau Pesuruhjaya Sumpah.

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991


BORANG PENDAFTARAN AH LI

KWSP 3 (AHL)

KEGUNAAN KWSP
10. MAJIKAN.

NO. AHL1:

fama Ponuii I'ekcrja:

UNTUK KEGUNAAN KWSP

NO. Kad Pengehalan:

Jantina:

o. K/P Lamu/Paspot:

Tarikh Lahir: _

A'arganegara:

I KWSP 3 [

KWSP 4

I Mama Ringkas

Keiurunan

j T'/tangan Pengesah:
j Jaw at an:
I'arikh:
CAP IBU JARI AJHLI
ku d a n m o n i v s a h k a n b a h a w a bu{'::.-:\':;;ai J; aia^ -idaiah beiul d a n ')cn;:r
u! iVm..'. liul..:' boiiau d a n k c d u a C'-.i|i
i b i i .!.;! in'>; i - i i i n d i ; i i r ' i n k ; i ' ! d i h a d a p a n say

a.

Tandatangan:
.
(Majikan. Wakil Majikan atau Pegawai KWSP)

S:i\a m c n e a k u b a h a w a b u l i r - b u l i r
vanu tcrcai ! il di alas adalah bctul
dan
benai
mcngikut
KaJ

K1RI

KANAN

reii;:en<iian S

Tandatangan:
(Pekerja)
Tarikh:

Jawatan:
No. K/Pengenalan:
Tarikh:
L1HAT DI B F L A K A N G
i ' i KM <-

v'i.-v'--:

A d'P i \ K A N

i-:.AI")

i'lN(,I'.N;\LA\.

.i A NIC i A N D l i ' L K A I K A N

MA A1ILI':
LA.MAT All LI:

TUAN/PUAN
yNDAITARAN K W S P 3
lAdalah d i m a k l u m k a n pecniohonan T u a n / P u a n untuk menjadi ahli K W S P telah diterima dan kad keahlian akan dihantar
epada T u a n / P u a n sebaik sahaja urusan pendaftaran telah d i s e i n p u n i a k a n .
ckian.

f.p l'engernsi Hksekutif


Lembaga Kunipulan Wang Simpanan Pekerja.
tarikh:

ALAMAT TUAN/
PUAN

ALAMAT WARIS
TERDEKAT:

NO. TELEFON

POSKOD

POSKOD

BANDAR

BANDAR

NEGERI

NEGERI
NO. TELEFON

PERHATIAN:
SEKIRANYA TUAN/PUAN TELAH BERPINDAH ALAMAT, SILA ISIKAN BORANG KWSP 1866 DAN HANTAR
KE PEJABAT KWSP YANG BERHAMPIRAN DENGAN TEMPAT TINGGAL TUAN/PUAN.

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991


BORANG PENAMAAN
Sava

No. K./P

KWSP4(A>!L)

dan No. Ahli

(NAMA AHLI)
menamakan mdividu seperti disebutkan
keatas diri sava.

di bawah un'uk menerima simpanan KWSP apabila berlaku kcniatian

NAM A

NO. K.P/SURAT BERANAK

PERTALIAN

SILA LIHAT DI BELAKANG


JANGAN DICERAIKAN

NAMA AHLI:
ALAVIA'I AHLI:

TUAN/PUAN
PENAMAAN KWSP 4
Adalah dimaklumkan penamaan Tuan/Puan bertarikh
l.Telah didaftarkan
2.Tidak dapat didaftarkan kerana belum mencapai 18 tahun/borang tidak lengkap.
Sekian.

b.p Pcnge.-usi Eksekutif


Lenibaga Kumpulan Wang Simpanan Pekcrja.
Tarikh:

BAHAG1AN

Penamaan ini bertarikh

Hniibulan

20

membaf.ilkan penainaan yang tcrdahulu

CAP IBU JAR! AHLI

AKUAN SAKSI
KIRI

KANAN

Saya dengan ini mengcsahkan kenyataan di alas telah dibuat


oleh ahli dan cap ibu jarinya telah diturunkan di hadapan sava.
Nama penuh saksi:
No k p saksi
Pekerjaan:
Alamat saksi:

PERHATIAN:
i) S e k i r a n y a c a p i b u j a r i k i r i / k a n a n r o s a k. si I a
tandaiangani pada scbelahan cap ibu jari lersebut

Tandatangan saksi.
Tarikh,
UNTUK
KBGUNAAN
KWSP
SAIIAJA

TARIKH TERIMA

'IARIKH DIDAFTAR

li) Jika s e o r a n g ahli K u m p u l a n Wang yang beragama


Islam mati dengan m e m b u a t p e n a m a a n mengikut
P e r a t u r a n - p e r a t u n n m i , orang atau b e b e i a p a orang yang
d i n a m a k a n itu h e n d a k l a h m e n e r i m a k i c d i t ahli \ a n g
mati itu s e b a g a i s e o r a n g wasi dan b u k a n n y a sebagai
b e n e f i s i a n dan hendaklah m e m b a h a g i - b a h a g i k a n kredit
itu mengikut U n d a n g - u n d a n g Islam.

KEGUNAAN KWSP SAHAJA

BUTIRAN AHLI
2 NOMBOR KAD PENGENALAN12 DIGIT

1. NOMBORAHU

! I I

KP

II I

I I

I
I

4 NOf/BORPOUS/TENTERA/PASPORT/DSB

3 NOMBORKADPENGENALAN7DIGIT

I I I

5. NAMA MENGIKUT KAD PENGENALAN/PASPORT

HURUFAWALAN

i II
I II

NAMAAHU

I I

1I

I I

I1

6 SEKTOR KERAJAAN
MOD PEMBAYARAN
WARAN

DRAF8ANKASING

ARAHAN1 BAYARAN

KREDITKEAKAUNBANK

BEKERJASENDIRI

SWASTA

KERAJAAN

TIDAK BEKERJA

7.JANTINA

LI

LFLAKI

PEREMPUAN

9 AMAUN YANG DIPOHON

KETURUNAN

SEN

RINGGIT MALAYSIA

1X11UJ

10 ALAMATAHLI

DISEMAKOLEH

[ TTTTTT

PEGAWAIPENYEMAK

ITn

T T l I 1 1 I 1 1 I I I I I II
r i IT
I TI I I I1
Li IT 1 LJLLXXl
TTT
rTXT"rrrT~rn~rT
POSKOD

NO K/TGN

BANDAR

NEGERI

U_L

11. NOMBOR TELEFON PEJABAT

TARIKri

DISAHKANOLEH
PEGAWAIPENGESAH

NOMBOR TELEFON RUMAH/EIMBIT

Ll I I I I FTZ

T I I I I

ADALAH SAYA DENGAN INI MENGAKU JAN Jl SEPERTIBERIKUT


1 MEMATUHI SEMUA SYARAT YANG DIKENAKAN OLEH LEMBAGA Dl BAWAH SKIM IN' DAN MEMAHAMIDENOAN PEMIUHAN INI LEMBAGA TIDAK AKAN
BERTANGGUNGJAWAB KE ATAS APA APA K
LEMBAGA Dl ATAS KERUGIAN TERSEBUT
2 APA-APA AMAUN YANG OIPINDAHKAN TIDAK TERMASUK DALAM PENAMAAN SAYA
3 SAYA JUGA FAHAM BAHAWA SAYA TIDAK BOLEH MEMBATALKAN PSRVOHONAN INI
12.

NO K/TGN

I I I I I

JENIS PENGELUARAN

NOMBOR AHLI

NOMBOR

TARIKH

KIRl

CAP IBU JARI KIRI


DILULUSKANOLEH:
PEGAWAIPEI.U1.US1

KANAN

DAN KANAN AHLI


(MESTI DITURUNKAN
DENGAN TERANG
DAN PENUH
MENGGUNAKAN

NO K/TGK

PAD CAP IBU JARI

I II

BERWARNA HITAM)

TARIKH

TARIKH

DILULUSKANOLEH
PEGAWAIPELULUS2

13. UNTUK DIISI OLEH INSTITUSI PENGURUSAN DANA (IPD)


KOD INSTITUSI PENGURUSAN DANA (RUJUK PANDUAN MENGISI BOR NG)
NOMBOR AKAUN/NO RUJUKAN PEMOHON

LHH

i i i i i i i i i

SAYA DENGAN INI MENGESAHKAN MAKLUMAT PDviOHON Dl ATAS


NO K/TGN

11
TARIKH

11

TANOATANGAN
TARIKH

NAMA PEGAWAI

COP RASMI

PANDUAN UNTUK MENGISI BORANG KWSP 9 F (AHL)


PEMBERITAHUAN PEMINDAHAN KREDIT UNTUK SKIM PELABURAN

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG BORANG PERMOHONAN MESTILAH
DIPENUHI DENGAN HURUF BESAR.

Nombor Ahll
Isikan sata digit di setiap ruang dengan didahului oleh dig.t '0' jika perlu seperti contoh di bawah
1. NOMBOR AHL!
r
Contoh
1234567
3 4 , 5 6
r

2.

Nombor Kad Pengenalan 12 Digit


Isikan nombor Kad Pengeiialan 12 digit t u a n / p u a n
digit, kosongkan rtiangan ini

Jlka t u a n / p u a n belum memiliki

Kad Pengtnalan 12

2. NOMBOR KAD PENGENALAN


Contoh

3.

610701-02-6157

1 0

1 7 , 0

1 I5

Nombor Kad Pengenalan 7 Digit


Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah
3 . NOMBOR KAD PENGENALAN 7 DIGIT

4-

a)

1234567

3 4 , 5 6

b)

A 1234567

c)

K 1234567

d)

H 1234567

3 , 4

Nombor Polis/Tentera/Pasport/Dsb
Isikan Nombor Polis/Tentera/Pasport/Dsb termasuk huruf awalan, seperti contoh di

bawah

4. NOMBOR POLIS/TENTERA/PASPORT/DSB

5.

a'

I 1234567

* S 6 |7

b)

T 1234567

(5

Nama Mengikut Kad Pengenalan/Pasport


Tuliskan nama tuan/puan seoagaimana yang tercalat dalam kad pengenalan tuan/puan
Jlka sama menglkut kad pengenalan ialah Norman bin Abdullah sila tuliskan nama seperti di bawah
5. NAMA MENGIhUT KAD PENGENA1 AN/PASPORI
N

R' M' A I N

1_

6.

Sektor Pekeriaan
Tandakan ( V ) di dalam ruang yang disediakan.
( V ) dalam ruang berkenaan sepertl di bawah :

Jlka tuan/puan bekerja dalam sektor swasta, tandakan

? SEKTOR PEKERJAAN
BEKERJA SENDIRI
I
KERAJAAN
SWASTA
TIDAK BEKERJA

Jantina
Tandakan jantina tuan/puan dengan ( V ) dalam ruang yang disediakan. Jika lelaki, tandakan (V) di ruang
yang berkenaan seperti di bawah :
7. JANTINA

8.

LELAKI

PEREMPUAN

Keturunan
Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, Isikan
seperti di bawah :
8. KETURUNAN

Melayu
Cina
India
Lain-lain

9.

1
2
3
4

5
6
7

Bidayuh
Kadazan
Iban

Amaun Dipohon
Isikan satu digit di setiap ruang dengan didahului oleh digit-digit '0' jika perlu. Jika amaun yang dikehendaki
oleh tuan/puan untuk pemindahan pelaburan (setelah berunding dengan IPD) adalah RM13,170.00, isikan
ruangan yang berkenaan seperti di bawah :
9. AMAUN DIPOHON
RINGGIT MALAYSIA
0

10.

SEN

Alamat Ahli
Tuliskan alamat surat menyurat tuan/puan dengan lengkap. Jika alamat surat menyurat tuan/puan adalah
Lot 10 Kg Parit Kadir Timur, Bukit Pasir, 84300 Muar, Johor Daru) Takzim, sila penuhl seperti berikut :
10. ALAMAT AHLI

POSKOD
8 4 3

BANDAR
M U A

NEGERI
J O H

I T

11.

Nombor Telefon
Isikan nombor telefon di ruangan yang disediakan dl bawah :
Contoh : Nombor Telefon Pejabat : 07 - 9859450
Nombor Telefon Rumah/Blmbit : 016 - 2070158
TELEFON RUMAH/BIMBIT
1
7
0
- ! 2 0

11. TELEFON PEJABAT


8

12.

_LLLLII I

Jenis Fengeluaran. Nombor Ahli. Nombor Kad Pengenalan dan Cap lbu Jar!
Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan
tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jarl berwarna hltam.

13.

BUTIRAN UNTUK DIISI OLEH INSTITUSI PENGURUSAN DANA

i.

Kod Instltusi Pengurusan Dana


Isikan kod yang telah diperuntukkan oleh KWSP kepada Institusl Pengurusan Dana (IPD) :
Contoh : Kod 'AIM Unit Trust Bhd" ialah 007
Isikan seperti berikut di kotak yang berkenaan

Nombor Akaun / Nombor Rujukan Pemohon


Tullskan nombor akaun / nombor rujukan yang diperuntukkan oleh IPD kepada pemohon.
Contohnya : Jika nombor akaun pelaburan pemohon ialah 123456789100001, isikan ruangan
seperti di bawah :

LI
HI.

0 ' 0

Pengesahan Nombor Pollsl / Nombor Rujukan Pemohon


Turunkan tandatangan, tuliskan nama pegawai dan cop rasmi IPD serta tarikh pengesahan di ruangan
yang disediakan.

n
NAMA
NO. AHLI
1.0

2.0

TEL:(P)

(R),

PENTING
11

Borang permohonan yang telah lengkap diisi hendaklah diserahkan kepada Institusi Pengurusan Dana
(IPD) yang dplih

12

Salman dokumen hendaklah disahkan oleh pegawai Institusi Pengurusan Dana (IPD) yang dipilih

13

Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam Tuan/puan hendaklah
menurunkan cap ibu jan kin dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Jan
berwarna hitam

14

Tuan/puan hendaklah memastikan dokumer dokumen yang disertakan bersama-sama dengan borang
permohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples)

15

Semua sahnan fotostat dokumen hendaklah menggunakan kertas saiz A4

16

KWSP berhak menolak mana-mana permohonan yang tidak lengkap

DOKUMEN UTAMA
Tandakan ( V ) dalam kotak yang berkenaan
21

Borang permohonan KWSP 9F(AHL) - 3 Salman


(1 sahnan disimpan oleh IPD dan 2 salinan untuk kegunaan KWSP)

22

Salman Kad Pengenalan ajau


Salman Kad Pengenalan Polis/Tentera dan
Surat Pengesahan Majikan menyatakan nombor Kad Pengenalan Awam aan
nombor Polis/Tentera merujuk kepada orang yang sama

Tandatangan Ahli

Tankh

Tandatangan Penenma

Tankh

KUMPULAN WANG SIMPANAN PEKERJA


1OGOS2001

KEGUNAAN KWSP SAHAJA

JENIS PENGELUARAN YANG DIPOHON: SILA TANDAKAN ( V ) Dl KOTAK YANG BERKENAAN


1. JENIS PENGELUARAN

KP

PENDIDIKAN

PENDIDIKAN ANAKAHU

BUTIRAN AHLI

HURUFAWALAN
NAMAAHU
2.NOMBORAHLI

3, NOMBOR KAD PENGENALAN 12 DIGIT

rrrr\

i I-I i i -i i

MODPEMBAYARAN
WARAN

DRAFBANKASING
ARAHAN8AYARAN

2
3

KREDITKE AKAUN BANK

5. NOMBOR POUS/TENTERA/PASPORT/DSB

4. NOMBORKADPENGENALAN7DIGIT

niTTTT I I I ! I I

6. KETURUNAN

7.JANTINA
LELAKI
PEREMPUAN

JENIS AKAUN

1
2

KONVENSIONAL
AL-WADIAH

8. NAMA MENGIKUT KAD PENGENAUN PASPORT

II

PENERiMABAYARAN
AHLI

INSTlTUSIPENGAJIAN
TiNGG!

INSTITUSIPEMBERI
PINJAMAN

I I I I I II I I
9.ALAMATAHU

i n i i n
POSKOD

BANDAR

TTTTl r r r r
NEGERI

i i i i i i i i i TTITTTT

NOMBOR TELEFON RUMAH/BIMBIT

10. NOMBOR TELEFON PEJABAT

I I I I I

M I N I
I I I

I I

DISEMAKOLEH:
PEGAWAIPENYEMAK

12. AMAUN DIPOHON UNTUK AHLI/ANAK AHLI


RINGGIT MALAYSIA
SEN

11. YURAN PENGAJIAN AHLI/ANAK AHLI


RINGGIT MALAYSIA

I
CAW

SEN

I I I I I

I I I I

UNIT

14. JENIS PEMBAYARAN

13. BAKIFINJAMAN PENDIDIKAN AHLI/ANAK AHLI


RINGGIT MALAYSIA

I I I I I

SEN

WARAN

ARAHANBAYARAN

DRAFBANKASING

KREDITKE AKAUN BANK

NO. K/TGN

TTTI

BUTIRAN AKAUN BANK (SEKIRANYA PEMBAYARAN DIBUAT KEPADA AHLI)

TARIKH.
16. KOD BANK

16. NOMBOR AKAUN BANK AHLI

' i i i i i i i i i i i i i i i i i i i
17. JENIS AKAUN
KONVENSIONAL
AL-WADIAH

BUTIRAM PELAJAR (ANAK AHLI) (SEKIRANYA MEI1OHON UNTUK PENDIDIKAN ANAK)


PEMBERITAHUAN
DISAHKANOLEH
PEGAWAIPENGESAH

18 NAMA PELAJAh Mf-Nbirs(JT KAD PENGENALAN

niErn

TTTTTTT
NO K/TGN

19 NOMBOR KAD PENGENAIAN 12 DIGIT

TARIKH
20 HUBUNGAN AH J DENGAN PELAJAR

AMAKTIRI

ANAK

ANAK ANGKAT

BUTIRAN LAIN

DILULUSKANOLEH
PEGAWAI PELULUS1

21 JAMA DAN CAWANGAN INSTITUSI PCNGAJIAN TINGGI

i
i
22 PERINGKATPENGAJIAN

P I

I I

23 TAHUN PENGAJIAN

H I

I I

I
I

24 LOKASI PENGAJIAN

NO K/TGN

25 NAMA PAN CAWANGAN INSTITUSI DFMBERI PINJAMAN

TARIKH

1X1 II
1
2

SAYA DENGAN INI MEMOhON UNTUKMENGELUA^KAN KREDITSAYADI KWSPtv'ENURUTPERUNTUKANAKTAKWSP 1991 SAYA JUGAAKAN
PATUHKEHLNDAK SEKCYCN 54(6)(G) PERUNTUKAN AKTAKWSP 1991
SAYA MEMBFt ARK AN KWSP MEMBUAT BAYARAN TER JS KEPADA INSTITUSI PFNGAJIAN TINGGI ATAU PEMBERI PIN JAMAN Dl MANA YANG
BERKtNAAN

PEGAWAI PELULUS 2

26
JENIS PENGi-LUARAN

NOMBOR AHII

NOMBOR

NO K/TGN
CAP IBU JARI KIRI
DAN KANAN AHLI
TARIKH

(MESTI DITURUNKAN
DENGAN TERANG
DAN PENUH
MENGGUNAKAN
PAD CAP IBU JARI
BERWARNA HITAM)

TARIKH

KIRI

KANAN

PANDUAN UNTUK MENGISI BORANG KWSP 9 H fAHLl


PENGELUARAN PENDIPIKAN ANAK

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAH
DIPENUHI DENGAN HURUF BESAR.

1.

Jenis Pengeluaran Yang Dipohon


Tandakan ( V ) dlmana berkenaan

2.

1.

JENIS PENGELUARAN

1.

PENDIDIKAN AHLI

2.

PENDIDIKAN ANAK AHLI

Nombor Ahli
Isikan satu digit di setiap ruang dengan didahului oleh digit '0' jika perlu, seperti contoh
Con ton

di bawah

: 01234567

2. NOMBOR AHLI
1 [_2

3.

Nombor Kad Pengenalan 12 Digit


Isikan nombor Kad Pengenalan 12 digit tuan/puan.
digit, kosongkan ruangan ini :

Jika tuan/puan belum memiliki Kad Pengenalan 12

Contoh : 610701 - 02 - 6157


3. NOMBOR KAD PENGENALAN 12 DIGIT
o| 7|o
o
4.

Nombor Kad Pengenalan 7 Digit


4.1

Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf avvalan, seperti contoh di bawah:
4. NOMBOR KAD PENGENALAN 7 DIGIT
a)

5.

1 i 2 [ 3 ' 4 fs \ 6~J~7

1234567

b)

A 1234567

c)

K 1234567

d)

H 1234567

3 4 1~5 ] 6 F 7

[K

T]2
1 I2!3

4| 5

6[ 7

Nombor Polis/Tentera/Pasport/Dsb
Isikan Nombor Kad Pengenalan Polis/Tentera/Pasport/Dsb tennasuk huruf awalan, seperti contoh di bawah:
5. NOMBOR/POLIS/TENTERA/PASPORT/DSB

6.

a)

I 1234567

b)

T 1234567

HID

Keturunan
Isikan ruang dengan menglkut kod keturunan di bawah lnl. Jika tuan/puan berketurunan Melayu, isikan
seperti di bawah :
6. KETURUNAN| 1
Melayu
Cina
India
Latn-lain

1
2
3
4

Bidayuh
Kadazan
lban

5
6
7

7.

Tandakan jantina tuan/puan cU ngan ( \ ) dalain ruang yang disediakan


yang berkenaan seperti di bawah
7 JANTINA

Jika lelaki tandakan ( V ) di ruang

IELAKI
I'F REMPUAW

Nama Mengikut Kad Pengenalan/Pasport


Tuhskan nama tuan/puan sebagaimana yang tercatat dalam kad pengenalin t u a n / p u a n
Jika sama mengikut kad pengf nalan ulah Norman bin Abdullah sila tuhskan nania seperti di bawah
8. NAMA MENGIKUT KAO I 1 NGENAI AN/P<\SPORT
'] O | R T M7~A^~N I

9.

] B

B | D

L ] L |~A ' H '

Alamat Ahli
Tuliskan alamat surat menyural tuan/puan dcngan lengkap Jika ilamat surat menyurat tuan/puan adalah
Lot 10 Kg Parit Kadir Timur Bukit Pasir 84300 Muai Johor Darul Tak/im Sila penuhi seperti berikut

LiO

1 0

1 I I M |U IRI
POSKOD

9 ALAMAT AHLI
P A R
I Tr

K[ G
_B J U K I

P A S

K A
1 R

1
1

BANDAR

j Q _J.T D

M1 U [ A I R

~8 4 ' 3}
NEGERI
^ , HTOI R!

10.

Nombor Telefon Pejabat & Nombor Telefon Rumah


Isikan nombor telefon pejabat dan uimah di ruangan yang disediakan di bawah
Contoh
Nombor Telefon Pejabat 07 9859450
Nombor Telefon Rumah/ Bimbit
10.
0 ' 7

11

TELEFON PEJABA1
r qT 8T" 9^4

016-2070158

TELEFON RUMAH 'BIMB1T


2 , 0 7 0 1 5

0 i 1 ' 6

Yuran Pengajian Ahli/Anak


Isikan satu nombor untuk Uap tiap satu ruangan Nombor kosong (0) di hadapan perlu dituhskan dalam
semua ruangan yang tidak dipenulu Jika yuian pengajian t u a n / p u a n atau anak t u a n / p u a n adalah
RM12 000 00, isikan ruangan \ang bei kenaan sepeiti di bawah
11 MIRAN I'ENGA.JIAN AHLI/ANAK
RINGGIT MALAYSIA T SEN

0 0 1J 2 l 0 0 I 0 Jo_O I

12.

Amaun Dipohon
Isikan satu nombor untuk tiap-tlap satu ruangan. Nombor 'kosong' (0) di hadapan perlu dituliskan dalam
semua ruangan yang tidak dipenuht. Jika tuan/puan memohon RM 10,000.00, isikan ruangan yang berkenaan
seperti di bawah :
12. AMAUN DIPOHON
RINGGIT MALAYSIA
SEN
_OJ 0 | 1 | 2 j 0 | 0 J 0 | 0
0

13.

Baki Piniaman Pendidikan Ahli/Anak Ahli


Isikan satu nombor untuk tiap-tiap satu ruangan. Nombor 'kosong' (0) di hadapan perlu dituliskan dalam
semua ruangan yang tidak dipenuhi. Jika tuan/puan memohon RM10.000.00, isikan ruangan yang berkenaan
seperti di bawah :
13. BAKI PINJAMAN PENDIDIKAN AHLI/ANAK AHLI
RINGGIT MALAYSIA I SEN
[ Oj_ 0J_1 | 0 0 0 j 0 ' 0 I 0

14.

Jenis Pembayaran
Tuan/puan boleh memilih salah satu cara pembayaran sepcrti berikut . Jika tuan/puan memllih Kredit Ke
Akaun Bank, sila tandakan ( V ) di ruangan yang berkenaan :
14. JENIS PEMBAYARAN

IS.

WARAN

ARAHAN BAYARAN

DRAF BANK ASING

KREDIT KE AKAUN BANK

Kod Bank
Isikan kod bank tuan/puan seperti contoh di bawah
Jika kod bank tuan/puan adalah Maybank
15. KOD BANK

RHB Bank
Maybank
Bumiputra Commerce
Public Bank
Hong Leong Bank
Hong Leong Finance
Affin Bank
EON Bank

16.

01
02
03
04
05
06
07
08

Arab Malaysian Bank


Alliance Bank
Southern Bank
Utama Bank
Bank Muamalat
Arab Malaysian Finance
BanL Islam

09
10
11
12
13
14
15

Nombor Akaun Bank


Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah
16. NOMBOR AKAUN BANK
1

6 .

17.

Jejiis Akaun
I s i k a n )( m-- a k a u n vans. 1 lipihl n h 1
( ) r|i m m s j a n \ a n e be i K> i> i n
17,

18,

i k i m a n p u tu infinilili Ak u r n Al W a d i a h

Mia l u u d a k i 1

) E \ ' I S AKAUN

KONVFNSIONAL
AI

in p u i'i

WADIAH

Nama Pelaiar (Anak Ahlii


T u h s k a n n a m a anak t u a n / p u a n
n a m a mengikut kad p e n g t n a l m

M b a ^ a n n a n a >ang u n a t a t dalam kail p< ngenalan anak t u a n / p u a n


lalah Muliamad bin Nounan, sila tuliskan aarna sepeiti di bawah

Jika

1 8 . KAMA I I I AJAK (ANAK AUI I)


M U H A M M A D

19

O K

M A N

Nombor Kad Pengenalan Pelajar


Isikan nombor Kad Pmfttiiilai
Contoh
7 8 1 1 0 5 0 " ! <>li>f->

i ' d ^ n i n iK t u i n | i\d{]

19. N O M B O R KAD PEN(,I \/\) ^


7

20.

OS

I'l I V J A R
i)

1 b

()

Hubungan Ahli Dengan Pelaiar


l a n d a k a n h u b u n g a n ahli d i n t i n pi i|ai ( a i n k t m m p u a n di n i a n g a n \ a n g d i s c d i a k a n
C o n t o h s e k i r a n v a h u b u n n a n i h l i d< i i " i n p c l a i a i i d i l a h i n a k k a n d u n g
20. HUBUNGA\
\N \K

21.

M i l 1 1)1 \ ( , A N I I I A I \ R

\ \ \ K ! <K\

W \K \ \ ( . k \l

Naima Dan Cawangan Institusi Pengajian Tinggi


T u l i s k a n n a m a d a n c a w a n g a n intiiuM pcnj,a]ian tmggi
C o n t o h iika n a m a m s t i t u s i pi nan<ui t m g ^ i t u a n / p u a n a t a u a n a k t u a n / p u a n m l a h
isikan scperti di b a w a h

22.

U i l M S h a h Alam

2 1 . NAMA DAN CAWANGAN IKSriTUSI PLNGAJIAN TINGGI


l 1 Ml
T s H A II
A I
A M

Peringkat Pengajian
I n l i s k i n p e n n g k a t p t n g a i n n l u u i pu \n u a u a n a k m a n p u a n nioiigikul kod sepeiti di b a w a h
22.
I]a/ah

Ija/ah I anpii in

I F RINGKAI PI NGA.JIAN
;

l a m I n n ^ a I t c. S e t i n f

Diploma

i 4

23.

Lokasi Pengaiian
Tuliskan lokasi pengajian tuan/puan atau anak tuan/puan mengikut kod seperti di bawah
Dalam Negara

24.

Lur Negara

Nama Dan Cawangan Institusi Pemberi Piniaman (Jlka Ada)


Tuliskan nama dan cawangan institusi pemberi pinjaman dengan lengkap
24. NAMA DAN CAWANGAN INSTITUSI PEMBERI PINJAMAN
M B| F
P

25.

E[T A L I

G|

|J

A Y

Jenis Pengeluaran. Nombor Ahll. Nombor Kad Pengenalan Dan Cap Ibu Jari
Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari klri dan kanan
tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.

NAMA
NO. AHLI
10.

TEL:(P)

PERHATIAN
1 1

Sekiranya permohonan diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannya bagi
tujuan pengesahan oleh Pegawai KWSP

12

Sekiranya tuan/puan mengemukakan salinan dokumen sahaja, sila pastikan semua sahnan dokumen telah
disahkan oleh pegawai yang dibenarkan oleh KWSP seperti berikut lengkap dengan nama dan cop rasmi
pengesah (kecuali salinan dokumen-dokumen tertentu yang telah ditetapkan Pegawai
Pengesahnya oleh KWSP):1 21

Pegawai KWSP yang terdiri danpada


- Pegawai KWSP Gred 18 ke atas
- Pegawai Kaunter KWSP
1 2 2 Majikan Pemohon
1 2 3 Penghulu atau Penggawa
124 Jaksa Pendamai

2.0.

(R).

125
126
127
1 28
1 29
1210

Pengamal Perubatan yang berdaftar


Penguambeladan Penguamcara
Kumpulan Pengurusan/Profesional Kerajaan
Ahli Dewan Undangan Negen
Ahli Parlimen
Pesuruhjaya Sumpah

13

Sekiranya permohonan bersama, sila sediakan 1 set dokumen bagi setiap permohonan

14

Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam Tuan/puan hendaklah
menurunkan cap ibu jan kin dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Jan
berwarna hitam

15

Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-bersama dengan


permohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples)

16

Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4

17

KWSP berhak menolak mana-mana permohonan yang tidak lengkap

DOKUMEN UTAMA
Tandakan (V) dalam kotak yang berkenaan
21

PENGELUARAN PENDIDIKAN AHLI


211

Borang permohonan KWSP 9H (AHL) - 2 salinan

2 12

Borang KWSP 3A (AHL) -1 salinan

213

Salman Kad Pengenalan ahli atau.


Salman Kad Pohs/Tentera dan Surat Pengesahan Majikan menyatakan
nombor Kad Pengenalan Awam dan Nombor Pohs/Tentera merujuk kepada
orang yang sama,

21 4

Sekiranya pembayaran dibuat kepada ahli, sila kemukakan salinan muka


hadapan Buku Akaun Bank yang mempunyai butir-butir akaun tuan/puan
atau Penyata Akaun Semasa yang asal Pemohon hendaklah menurunkan
cap ibu jan km dan kanan di atas salinan tersebut Sekiranya tuan/puan
menghantar melalui pos, salinan dokumen hendaklah disahkan oleh
Pegawai Bank berkenaan dan sek>fanya diserahkan di kaunter sila
kemukakan dokumen asal beserta salinannya bagi tujuan pengesahan
oleh Pegawai Kaunter KWSP

2.1.5. Surat tawaran kemasukan ke Institusi Pengajian Tmggi (merujuk Tahun 1,2,3
dan seterusnya)
(Sekiranya salman surat tawaran dikemukakan, hendaklah disahkan oleh Pegawai
IPTyang diben kuasa atau Pegawai KWSP seperti di para 1.2.1)
2 1 6. Surat pengesahan yang mengesahkan jumlah yuran pengajian yang dikeluarkan
oleh Institusi Pengajian Tmggi yang mengandungi butiran:
(a)
(b)
(c)
2.2

Nama dan nombor kad pengenalan ahli


Jems kursus di penngkat Diploma ke atas
Tahun pengajian

PENGELUARAN PENDIDIKAN ANAK AHLI


2 2 1 . Borang dan dokumen seperti para 2 1 . 1 - 2 1 4
2.2 2. Salinan Kad Pengenalan Anak Ahli
2.2 3. Salman SIJII Kelahiran AnaK/Sijil Pengesahan Anak Angkat /
(bukti pertahan bagi anak tin)

SIJII

Perkahwinan

2 2 4. Surat tawaran kemasukan ke Institusi Pengajian Tmggi (merujuk Tahun 1, 2,3


dan seterusnya)
(Sekiranya salinan surat tawaran dikemukakan, hendaklah disahkan oleh Pegawai
IPTyang diben kuasa atau Pegawai KWSP seperti di para 121)
2.2.5. Surat pengesahan yang mengesahkan yuran pengajian yang dikeluarkan oleh
Institusi Pengajian Tmggi mengandungi butiran (a) Nama dan nombor kad pengenalan anak ahli
(b) Jems kursus di penngkat yazah, yazah lanjutan atau yang setaraf dengannya
untuk ahli di Institut Pengajian Tmggi yang berkenaan
(c) Tahun pengajian
3.0.

DOKUMEN TAMBAH AN
3.1

Pembayaran Kepada Institusi Pengajian Tmggi Dalam Negara


Bagi Permohonan Ahli/Anak Dalam Tahun Pertama
(i)

Surat pengesahan pendaftaran danpada Institusi Pengajian Tmggi


a) Nama dan nombor kad pengenalan ahli/anak ahli
b) Jems kursus di penngkat Diploma ke atas untuk ahli dan di peringkat ijazah,
ijazah lanjutan atau yang setaraf dengannya untuk anak ahli di Institusi
Pengajian Tmggi yang berkenaan
c) Tahun pengajian

3.2

3.3.

Pembayaran Kepada Ahli Di Mana Ahli/Anak Ahli Mengikuti Pengajian Di Institusi Pengajian
Tmggi Luar Negara

(i)

Pasport

(n)

Visa pelajar (jika berkenaan)

Pembavaran Balik Kepada Ahli


(i)

Resit pembayaran yuran pengajian yang tidak melebihi 1 tahun dan tankh
permohonan.
(Sekiranya salinan resit pembayaran dikemukakan, hendaklah disahkan oleh
Pegawai IPTyang diben kuasa atau Pegawai KWSP seperti di para 1 2.1)

23.

Lokasi Pengalian
Tullskan lokasi pengajiP.n tuan/puan atau anak tuan/puan mengikut kod seperti dl bawah
Dalam Negara

24.

Lur Negara

Nama Dan Cawangan Institusi Pemberi Pinjaman (Jika Ada)


Tuliskan nama dan cawangan tnstltusi pemberi ptnjaman dengan lengkap :
24. NAMA DAN CAWANGAN INSTITUSI PEMBERI PINJAMAN
M B F
F I N A NI C[E
B H D
P E T A L

25.

I N

A Y

ZULU I

Jcnis Pengeluaran. Nombor Alili. Norabor Kad Pentfcnalan Pan Cap lbu Jari
Isikan jenis pengeluaran, nombor anil, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan
tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.

KEGUNAAN KWSP SAHAJA

BUTIRAN A H L I
1 NOMBORAHLI

I I II
3

2 NOMBOR KADPENGENALAN12 DIGIT

IT

I1

I I I I

NOMBORKADPENGENALAN7DIGIT

4 NOMBOR POLIS/TENTERA/PASPORT/DSB

I I

HURUFAWALAN
NAMAAHLI

II

5 KETURUNAN

ITI

6 NAMAMENGIKUTKAD PENGENALAN/PASPORT

r i i i

1 I TTI
I M T\

FTTI

MOD PEMBAYARAN
WARAN

DRAFBANKASING

ARAHANBAYARAN

KREDITKE AKAUN BANK

I I I I
I I 1I
I I I I

7 JANTINA
LELAKI
PEREMPUAN

PERBELANJAAN SEBENAR / ANGGARAN


9 KOS DIBIAYAIOLEH MAJIKAN

I PERBELANJAANPERUBATAN

JENIS AKAUN
KONVENSIONAl

AL WADIAH

SEN

RINGGIT MALAYSIA

I I I

RINGGIT MALAYSIA

II

I I

SEN

10 ORANG MENERIMA RAWATAN

AMAUN OIBAYAR

SEN

RINGGIT MALAYSIA

II

1 AHLI 3ENDIRI

4 IBU

7 ADIK BERADIK

2 SUAMI

5 BAPA

8 ORANG YANG DILULUSKAN

3 ISTERI

6 ANAK

I I I

OLEH LEMBAGA

11 NAM^ ORANG YANG MENERIMA RAWATAN (JIKA BUKAM AHLI SE NDIRI)

I I

T
I I

KODPENERIMABAYARAN
AHLI

PUSATPERUBATAN

T T
I I I

I I

I I

12 NO KADPENGENALAN/SIJILKELAHIRANORANC YANG MENERIMA RAWATAN

I I I
\

I I I I I I I I I

I I
M

13 ALAMATAHLI

I I
I I
DISEMAKOLEH
PEGAWAIPENYEMAK

I I

I I

POSKOD

I I

BANDAR

IT IN

I I I I I I I I I I I

NEGFRI

CAW

UNIT

i n

I
I

T I

NOMBOR TELEFON RUMAH/BIMBIT

I I

TARIKH

i i i i

15 JENIS PEMBAYARAN

14. NOMBOR TELEFONPEJABAT

NO K/TGN

I I I

I I I I I I

LL

WARAN

ARAHANBAYARAN

DRAFBANKASING

KREDITKE AKAUN BANK

BUTIRAN AKAUN BANK (SEKIRANYA PEMBAYARAN DIBUAT KEPADA AHLI)


16 KODBANK

JLU
18 JENIS AKAUN
KONVENSIONAL
AL WADIAH

17 NOMBOR AKAUN BANK

I I I I I ITTT l i n

I TTI

I I

NOMBORAHU

EF T

NOKAOPENGENALAN

I I I I J U T I I J.

JEMSPENCELUARAN

BUTIR-BUTIR PESAKIT

NAMA SUAMI / ISTERI YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA

SILA NYATAKAN NAMA PENUH, NO KAD PENGENALAN DAN UMUR

(POTONG Dl MANA TIDAK BERKENAAN)

NAMA MENGIKUT KAD PENGENALAN

NO KAD PENGENALAN

UMUR

in)
IV)

NAMA ANAK-ANAK YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA, SILA NYATAKAN NAMA PENUH, JANTINA, NO KAD PENGENALAN DAN
UMUR

NAMA MENGIKUT KAD PENGENALAN

JANTINA

NO KAD PENGENALAN

UMUR

in)

NAMA IBU / BAPA YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA, SILA NYATAKAN NAMA PENUH, JANTINA, NO KAD PENGENALAN DAN
UMUR
NAMA MENGIKUT KAD PENGENALAN

JANTINA

NO KAD PENGENALAN

NAMA ADIK-BERADIK YANG BERUMUR 16 TAHUN KEATAS YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA

UMUR

SILA NYATAKAN NAMA PENUH,

JANTINA, NO KAD PENGENALAN DAN UMUR

NAMA MENGIKUT KAD PENGENALAN


i)
II)

IV)

JANTINA

NO KAD PENGENALAN

UMUR

BUTIRAN HOSPITAL / INSTITUSI PERUBATAN / KESIHATAN


PEMBERITAHUAN
DISAHKANOLEH:
PEGAWAIPENGESAH

19. NAMA HOSPITAL / INSTITUSI PERUBATAN / KESIHATAN

i I II I I I
Mill
II

I I I I I
I I I I I

I I I
I I I

NO K/TGN
20. ALAMAT HOSPITAL /INSTITUSI PEflUBATAN / KESIHATAN

Mill

I
I

TARIKH

I IIIII I I

I I II I I I I I I
I I I I I I I M M
I II I I I II

POSKOD

BANDAR

i i ii

i i

NEGERI

LL
1.
DILULUSKANOLEH:
PEGAWAIPELULUS1

111

I I I I II T

I I T IT I I I

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA
KWSP 1991.
SAYA BERSETUJU SUPAYA JUMLAH KREDIT YANG DIKELUARKAN DARI AKAUN SAYA DIBAYAR TERUS KEPADA
HOSPITAL/INSTITUSI PERUBATAN/KESIHATAN MENGIKUT JUMLAH DALAM BIL YANG OIPERSETUJUI OLEH SAYA
(JIKA AHLI MENGGUNAKAN SURAT JAMINAN KWSP UNTUK MENERIMA RAWATAN)

21.
JENIS PENGELUARAN
NO K/TGN

NOMBOR AHLI

CAP IBU JARI KIRI

1ARIKH

DAN KANAN AHLI


(MESTI DITURUNKAN
DENGAN TERANG
DAN PENUH
MENGGUNAKAN
PAD CAP IBU JARI
BERWARNA HITAM)

TARIKHPEGAWAIPELULUS2

NO K/TGN

I I I I I
TARIKH

KIRI

NOMBOR

KANAN

PANDUAN UNTUK MENGISI BORANG KWSP 9D (AHL)


PEMBERITAHUAN PENGELUARAN KESIHATAN

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAH
DIPENUHIDENGAN HURUF BESAR.

1.

Nombor Ahll

Isikan satu digit di setiap ruang dengan didahului oleh digit '0' jiKa perlu, seperti contoh di bawah
Contoh : 1234567
1. NOMBOR AHLI
0

Nombot Kad Pengenalan 12 Digit


Isikan nombor Kad Pengenalan 12 digit tuan/puan.
12 digit, kosongkan ruangan ini :

Jika tuan/puan belum memilikl Kad Pengenalan

Contoh : 610701-02-6157
2. NOMBOR KAD PENGENALAN 12 DIGIT
0

Nombor Kad Pengenalan 7 Digit


Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah :
3. NOMBOR KAD PENGENALAN 7 DIGIT

4.

a)

1234567

b)

A 1234567

c)

K 1234567

d)

H 1234567

Nombor Polls/Tentera/Pasport/Dsb
Isikan Nombor Kad Pengenalan Polls/Tentera/Pasport/Dsb termasuk huruf awalan, seperti contoh di bawah

5.

a)

b)

T 1234567

4. NOMBOR POLIS/TENTERA/PASPORT/DSB
4 5 6 7
2
3

1234567

" 4~1 5 "

Ketnrunan

Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, isikan
seperti di bawah :
5. KETURUNAN [ 1

Melayu
Cina
India
Lain-lain

1
2
3
4

Bidayuh
Kadazan
Iban

5
6
7

6.

Nama Mengikut Kad Pengenalan/Pasport


Tuliskan nama tuan/puan sebagaimana yang tercatat delam kad pengenalan tuan/puan. Jlka nama mengikut
kad pengenalan ialah Norman bin Abdullah, sila tuliskan nama seperti di bawah :

N O R

6. _NAMA MENGIKUT KAD PENGENALAN/PASPORT


r
N
B I I N
A B D U ! L

1JL
7.

Jantina
Tandakan jantina tuan/puan dengan K) dalam ruang yang disediakan
yang berkenaan seperti di bawah

Jika lelaki, tandakan K ) di ruang

7. JANTINA
LELAKI
PEREMPUAN
Perbelanjaan Perubatan
Sebenar/anggaran ialah bil perubatan yang telah atau akan dikenakan oleh pusat rawatan yang diktiraf.
Kos rawatan akan dikenakan oleh pusat rawatan yang diiktiraf. Jika kos rawatan yang dikenakan untuk
penyakit kanser ialah RM 10.000 00, isikan seperti di bawah
8. PERBELANJAAN PERUBATAN
SEN

RINGGIT MALAYSIA
0

9.

Kos Yang Dibiavai Oleh Maiikan


9. KOS YANG DIBIAYAI OLEH MAJIKAN
SEN
RINGGIT MALAYSIA

Kos rawatan yang dibiayai oleh majikan. Contohnya


Kos rawatan pesakit (isteri) RM 10,000.00
Biayai majikan: RM 4,000.00
Isikan seperti berikut .

10.

Orang Yang Menerima Rawatan


Tandakan hubungan pesakit dengan pemohon di ruangan berkenaan
Contoh: Pesakit ibu, tandakan ( ^ )
10. ORANG YANG MENERIMA RAWATAN
1. AHLI SENDIRI

4 IBU

7. ADIK-BERADIK

2. SUAMI

5 BAPA

8. ORANG YANG DILULUSKAN

3. ISTERI

6. ANAK

OLEH LEMBAGA

Nama Orang Menerima Rawatan (Jika bukaa ahli sendiri)


Jika orang yang menerima rawatan adalah ibu tuan/puan, isikan nama ibu tuan/puan di dalam petak-petak
yang berkenaan. Jika nama ibu t u a n / p u a n adalah Julia bte Ahmad, tuliskan seperti di bawah :
1 1 . NAMA ORANG MENERIMA RAWATAN (JIKA BUKAN \HL1 SENDIRI)
J

12.

No. Kad Pengenalan/ Sijlll Kelahiran Orang vang Menerima Rawatan


Islkan No. Kad Pengenalan orang yang menerlma rawatan. Contohnya, jlka No. Kad Pengenalan ibu tuan/
puan ialah 450903 - 01 - 2346, tullskan sepertl dl bawah :
12. NO. KAD PENGENALAN/ SIJIL KELAHIRAN ORANG YANG MENERIMA RAWATAN
0

13.

Alamat Ahli
Tullskan alamat surat menyurat tuan/puan dengan lengkap. Jlka alamat surat menyurat tuan/puan adalah
Lot 10, Kg Pant Kadlr Tlmur, Buklt Paslr, 84300 Muar, Johor Darul Takzlm, slla penuhl sepertl berlkut

1
U

POSKOD
8

13. ALAMAT AHLI


I
T
P A R
I

BANDAR
0

A. 1 R

NEGER1
J

14.

Nombor Telefon
Islkan nombor telefon dl ruangan yang dlsedlakan dl bawah :
Contoh : Nombor Telefon Pejabat : 07 - 9859450

dan

Nombor Telefon Rumah/Blmbit : 016 - 2070158

14. NOMBOR TELEFON PEJABAT


8

NOMBOR TELEFON RUMAH/BIMBIT


2 0
7 10 1 5 8

IS.

Jenis Pembavaran
Jika t u a n / p u a n memilih kaedah pembayaran kredit ke akaun bank, tanda K ) dl ruang yang berkenaan
sepertl dl bawah ;
I S . JENIS PEMBAYARAN

16.

WARAN

ARAHAN BAYARAN

DRAF BANK ASING

KREDIT KE AKAUN BANK

1'

Kod Bank
Isikan nombor kod bank dl ruangan yang disediakan seperti di bawah
Jlka kod bank tuan/puan adalah Maybank
16. KOD BANK

RHB Bank
Maybank
Bumiputra Commerce
Public Bank
Hong Leong Bank
Hong Leong Finance
Affin Bank
EON Bank

01
02
03
04
05
06
07
08

Arab Malaysian Bank


Alliance Bank
Southern Bank
Utama Bank
Bank Muamalat
Arab Malaysian Finance
Bank Islam

09
10
11
12
03
13
14

17,

Nombor Akaun Bank


Jika nombor akaun bank adalah 1-23456 -789012-3, islkan ruangan berkenaan sepertt di bawah :
17. NOMBOR AKAUN BANK

3 I9 | 0

18.

Jenip Akaun
Jika akaun tuan/puan adalali jenis konvensional, tanda ( / ) di ruang yang berkenaan sepcrti di bawah
18. JENIS AKAUN
KONVENSIONAL
AL-WADIAH

19.

Nama Hospital/Institusi Perubatan/Kesihatan

Jika tuan/puan/pesakit mendapat rawatan daripada Pusat Pakar Utara Sdn. Bhd., sila tuliskan seperti di
bawah :

20.

19. NAMA HOSPITAL INSTITUSI PERUBATAN/KESIHATAN


P A K
A R A
A T
A1 R
U T
B

Alamat Hospital/Institusi Perubatan/Kesihatan


Jika alamat hospital berkenaan adalah No. 21, Jalan 11/2, 40000 Shah Alam, Selangor Darul Ehsan,
Tuliskan seperti di bawah :
20. ALAMAT HOSPITAL/INSTITUSI PERUBATAN/KESIHATAN
N

POSKOD
4

BANDAR

NEGERI
S

21.

Jenis Pengeluaran. Nombor Ahli. Npmbor Kad Pengenalan Dan Cap Ibu Jar!
Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan
tuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hltam.

NAMA

NO. AHLI :

1.0

TEL:(P)

PERHATIAN
1.1

Sekiranya permohonan diserahkan di kaunter KWSP, sila kemukakan dokumen asal beserta salinannya
untuktujuan pengesahan oleh Pegawai KWSP.

1.2

Sekiranya tuan/puan mengemukakan salinan dokumen sahaja, sila pastikan semua salinan dokumen telah
disahkan oleh pegawai yang dibenarkan oleh KWSP seperti berikut lengkap dengan nama dan cop rasmi
pengesah (kecuali salinan dokumen-dokumen tertentu yang telah ditetapkan Pegawai
Pengesahnya oleh KWSP):
1.2.1. Pegawai KWSP yang terdiri daripada
- Pegawai KWSP Gred 18 keatas
- Pegawai Kaunter KWSP
1.2.2. Majikan Pemohon
1.2.3. Penghulu atau Penggawa
1.2.4. JaksaPendamai

2.0

(R).

1.2.5.
1.2.6.
1.2.7.
1.2.8.
1.2.9.
1.2.10.

Pengamal Perubatan yang berdaftar


Peguambela dan Peguamcara
Kumpulan Pengurusan/Profesional Kerajaan
Ahh Dewan Undangan Negeri
Ahli Parlimen
Pesuruhjaya Sumpah

1.3

Sekiranya permohonan bersama, sila sediakan I set dokumen bagi setiap permohonan.

1.4

Setiap borang permohonan hendaKlah ditulis dengan pena dakwat berwarna hitam. Tuan/puan hendaklah
menurunkan cap ibu jari kiri dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Jari
berwama hitam.

1.5

Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-sama dengan borang


permohanan DIKLIPKAN dan tidak menggunakan dawai kokot (staples).

1.6

Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4.

1.7

KWSP berhak menolak mana-mana permohonan yang tidak lengkap.

DOKUMEN UTAMA
Tandakan ( V ) dalam kotak yang berkenaan
2.1

Borang Permohonan KWSP 9D (AHL) - 2 salinan

2.2

Borang KWSP 3A (AHL) -1 salinan

2.3

Salinan Kad Pengenalan ahli, ateu

Salinan Kad Pengenalan Poiis/Tentera dan Surat Pengesahan Majikan menyatakan


Nombor Kad Pengenalan Awam dan nombor Polis/Tentera merujuk kepada orang
yang sama.

I
|

2.4

Salinan muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan slau
Penyata Akaun Bank Semasa yang asa! Pemohon hendaklah menurunkan cap ibu jari kiri dan
kanan di atas salinan tersebut. Sekiranya tuan/puan manghantar melalui pos, salinan dokumen
hendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, sila
kemukakan dokumen asal beserta salinannya bagi tujuan pengesahan oleh Pegawai Kaunter
KWSP.

2.5

Laporan Perubatan yang tidak melebihi satu tahun yang mengandungi:


(a)
(b)
(c)
(d)
(e)
(f)

Butiran Pesakit
Keadaan Kesihatan semasa Pesakit
Tankh Laporan
Nama Pusat Perubatan
Nama dan Cop Rasmi Doktor
Tandatangan Doktor

(Sekiranya salinan Laporan Perubatan dikemukakan, hendaklah disahkan oleh Doktor/Hospital


berkenaan atau Pegawai KWSP seperti di para 121)
2.6

Surat pengesahan dan maiikan samada kos rawatan dibiayai oleh majikan atau tidak

[__

(Sekiranya pesakit adalah anak pengesahan majikan ibu dan bapa diperlukan dan sekiranya
pesakit bekerja, surat pengesahan majikan pesakit juga diperlukan Bagi pesakit Dasangan suami
isten, pengesahan majikan pesakit dan pasangan diperlukan)
27

Bil dan resit bayaran dan pusat perubatan yang tidak melebihi satu tahun dan tankh permohonan
(jika bayaran telah dibuat)
ATAU
Anggaran kos rawatan dan pusat perubatan atau pakar bagi rawatan yang dilakukan bagi ahli
yang memerlukan surat jaminan KWSP untuk mendapatkan rawatan
(Sekiranya salinan bil/resit bayaran/anggaran kos rawatan dikemukakan, hendaklah disahkan
oleh Doktor/Hospital berkenaan atau Pegawai KWSP seperti di para 1.2.1)

2.8

Bukti pertahan di antara ahli dan pesakit. (Jika pemohon bukan pesakit)

Tandatangan Ahli

Tankh

Tandatangan Penenma :

Tankh

KUMPULAN WANG SIMPANAN PEKERJA


1 OGOS 2001

KWSP9C (AML)
PERCUMA
AKTA KUMPULAN WANG SIMPANAN PEKERJA1991
PEMBERITAHUAN PENGELUARAN
MEMSEU / MEMBINA RUMAH ATAU MENGURANGKAN / MENYELESAIKAN PINJAMAN
PERHATIAN MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATA'J TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEMBERIKAN APA-APA
DOKUMEN PALSU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MELAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BOLEH DIDENDA ATAU DIPENJARA ATAU
KEDUA-DUANYA
1

KEGUNAAN KWSP SAHAJA

JENIS PFNGELUARAN YANG DIPOHON SILA TANDAKAN I -J) PI KOTAK YANG BERKENAAN
1 JENIS PENGaUARAN

KP

PERTAMA

MEMBai / MEMBINA RUMAH

MENGURANGKAN / MENYaESAIKAN PINJAMAN

MENGURANGKAN / MENYaESAIKAN PINJAMAN PASANGAN

HURUF AWALAN
NAMA AHLI

KEDUA

BUTIRANAHU
2 NOMBORAHLI

3. NOMBOR KAD PENGENALAN 12 DIGIT

4 NO KAD PENGENALAN 70IGIT/POUS/TENTERA/PASPORT/DSB

5 TARIKH SURATPERJANJIAN JUAL BELI

MOD PEMBAYARAN
WARAN

DRAF BANK ASING

ARAHAN BAYARAN

KREDITKEAKAUNBANK

7 NAMA MENGIKUT KAD PENGENALAN/PASPORT

JANTINA

1ELAKI
PEREMPUAN

1
10 JUMAH PINJAMAN / BAKI PINJAMAN

9 HARGA BaiAN / KOS PEMBINAAN


KOD PINJAMAN

SEN

RINGGIT MALAYSIA

RINGGIT MALAYSIA

SEN

AHLI
PASANGAN
11 SEKTOR PEKERJAAN

JENIS AKAUN
KONVENSIONAL

ALWADIAH

12 BUTIRANHARTA

BEKERJASENDIRI

NO LOT/PT

KERAJAAN

NO HS(M/D)

SWASTA

NO PARCEL

TIDAK BEKERJA

FLAT/APP/
KONDOMINIUM

13 ALAMAT HARTA
DISEMAKOLEH
PEGAWAI PENYEMAK
|
POSKOO

BANDAR

NEGERI

14 ALAMAT AHLI

CAW

UNfT

I
POSKOD

I I

BANDAf

NOK/TGN
NEGERI

TARIKH

16 JENIS PEMBAYARAN

15 NOMBOR TaEFON (PEJABAT)


NOMBOR TaEFON (RUMAH)
i

WARAN

ARAHAN BAYARAN

DRAF BANK ASING

KREDITKEAKAUNBANK

BUTIRAN BANK
17 KOD BANK

18 NOMBOR AKAUN BANK (Hanya untuk membei/membma mmah)

I I

19 JENIS AKAUN

20 NOMBOR AKAUN PINJAMAN PERUMAHAN


(Hanya untuk mengurang/menyetesakan pin|amanj

KONVENSIONAL
AL-WADIAH

6 KETURUNAN

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991


PEMBERITAHUAN PENGELUARAN
50 TAHUN/55 TAHUN/DIVIDEN/KETIDAKUPAYAAN

KWSP98(AHL)
PERCUMA

PERHATIAN
MANAMAM ORAN& YANG MEMBUAT W APA KENYA MAN U N G TIDAK BETUL \TAU TIDAK BENAP A I A U M NGFMUKAKAN ATAU MEMBERiKAN APAAPA DOKUVLN PAISL
JALAM A H A / O A BUTIRBUTIR MUSTAhAK ADALAH MELAKJKAN KfcSALAHAN DAN AKAN MENYE8ABKAN ) RlNYA BOLEH DIDENDA ATAU DIPENJARA ATAU KEDUA DUANYA

KEGUNAAN KWSP SAHAJA


KP

KJRLFAWALAN
\|AKA AHL

SILATANOAKAN (V) Dl KOTAKYANGBERKbNAAN


1 JENIS

L"X_"

50 TAHUN

i5 TAHUN
1

PtNGELLARAN

KE [IDAKUPAYAAN

DI/IDEN

'

MOD PFMBAYARAN

LNTUK PENGELUARAN 55TAHUN


FKIRANYA AHLI MASIH BEKERJA DAN NGIN IfcRUS
\FNCARUM TANDAKAN
(V) Dl RUANGAN BERKENAAN
NblN TERUS MENCARUM YA (
) "IDAK (
) JIKA M
bILA ISIKAN BORANG KWSP 20 (AHL) DAN KWSP ?0A AriL)
i iiiTiii/ nc^rrtCi I I A D I U DCUIIU
UNTUK
PENGELUARAN PENUH
TIDAK (
ADA PEMINDAHAN PELABURAN YA (

BUTIRANAHIl

/VARAN
2 NOMBOR AHII

DRAFBANKASING

1 I OMBOR KAD PENGENALAN 12 DIGIT

\RAHAN BAYARAN
KREDIT KEAKAl IN BANK
4

NOMBOR KAD PENC EN \LAN 7 DIGIT

KONVENSIONAL
Al WADIAH

NOMBfR POMS TENTERA/PASPORT/DSB

6 NAMA MENGIKUT KAD PENGENALAN/PASPARr

nzz

STATUS AKAJNAHU

nrrnm
nnznznn: nxizn

__JENISAKAUN

_L I
8 TARIKH LAHIR

h
I

10 SEKTOR PEKERJAAN

LEuAKI

Pt.NE.RiVK BAY/"AN

t. _

TJ

9 JANTINA

7 KETURUNAN

PEREMPUAN

AHL!
11 ALAMATAHU

UISEMAK OLEH
PFGAWAI PFNYFMAK
PJ&KOD

AW

I r

BANDAR

NEGfcRI

NIT

i n u i in iTxrn:

JZLT:

WARAN
N
NOMBOR TbLEFON RUMAH/BIMBIT

16 JENIS_AKAUN
14 KOOBANK

NO KTGN

11) NC MBOR AKAUN BANK

nn

KONVENSIONAL

nL WAOIAt

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Di KWSP MENURUT PERUNTUKAN AKTA KWSP 1991

17
JENIS PENIGtLUARAN

ARKH
DILULoSKAN OLtH
PECAWM PELJLUS 1

NOMBOKAHU

T ""I
NOVRO'< Wf

K1SJ
CAP Bt i R K R ( AN
KANANAHLI
(MESTI DITJKUNKAN DtNOAN
TrRAMGDANPENJH

NO
J.

CAMBUJARIBf-RW RNA
H AM)

ARKH
PEGAWAI PELULUS 2

NO K/TGN

TARIKH

KREDIT KEAKAUN BANK

BUTIRAN AKAUN BANK

DISAHKANOLEH
PLGAWAI PENGESAH

L.

ARAHAN BAYARAN

BANK \SING

njznjrr

1 \RIKH

~T~T
L_

13 JENIS PEMBAYARAN

12 NOMBOR TELEFON PEJABAT

NO KTCN

1ARIKI-

j'
MNAH

LJ

KUMPULAN WANG SIMPANAN PEKERJA


SENARAISEMAKAN SKIM PENGELUARAN PERSARAAN
50 TAHUN/55 TAHUN/DIVIDEN
NAMA

NO.AHL!

1.0

TEL: (P)

(R)

PERHATIAN
1.1.

Sekiranya permohonan diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannya
bagi tujuan pengesahan oleh Pegawai KWSP.

1.2.

Sekiranya tuan/puan mengemukakan salinan dckumen sahaja, sila pastikan semua salinan telah
disahkan oleh pegawai yang dibenarkan oleh KWSP seperti bcrikut lengkap dengan nama dan cop
rasmi pengesah : 1.2.1.
1.2.2
1.2.3
1.2.4
1.2.5

2.0

,.

Pegawai KWSP yang terdiri daripada


- Pegawai KWSP Gred 18 keatas
Pegawai Kaunter KWSP
Majikan Pemohon
Penghulu atau Penggawa
Jaksa Pendamai
Pengamal Perubatan yang berdaftar

1.2.6.
1.2.7.

Peguambela dan Peguamcara


Kumpulan Pengurusan/Profesional
Kerajaan
1.2.8. Ahli Dewan Undangan Negeri
1.2.9. Ahli Parlimen
1.2.10. Pesuruhjaya Sumpah

1.3.

Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam. Tuan/puan
hendaklah menurunkan cap ibu jari kin dar kanan dengan terang dan penuh menggunakan Pad
Cap ibu Jari berwarna hitam.

1.4.

Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-sama dengan


borang permohonan DIKUPKAN dan tidak menggunakan dawai kokot (staples).

1.5.

Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4.

1.6.

KWSP berhak menolak mana-mana permohonan yang tidak lengkap.

DOKUMEN UTAMA
Tandakan (V) dalam kotak yang berkenaan.
2.1.

Borang permohonan KWSP 9B(AHL) - 2 salinan

2.2.

Borang KWSP 3A (AHL) - 1 salinan

2.3.

Salinan Kad Pengenalan


Salinan Kad Pengenalan Polis/Tentera dan
Surat Pengesahan Majikan menyatakan No. Polis/Tentera dan
No. Kad Pengenalan merujuk kepada orang yang sama

3.0

24

Salinan pasport bagi warganegara aslng


(Sila kemukakan salinan pasport yang lama sekiranya nombor pasport terkini
berbeza dengan rekod KWSP)

25

Salinan muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun
tuan/puan atau Penyata Akaun Bank Semasa yang asal. Pemohon hendaklah
menurunkan cap ibu jari kin dan kanan di atas salinan tersebut. Sekiranya tuan/puan
menghantar melalui pos, salinan dokumen hendaklah disahkan oleh Pegawai Bank
berkenaan dan sekiranya diserahkan di kaunter, sila kemukakan dokumen asal beserta
salinannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSP

DQKUMEN TAMBAHAN
31

Sijil Kerakyatan/Syil Kelahiran (jika No Kad Pengenalan tiada dalam rekod KWSP)

Tandatangan Ahli
Tandatangan Penerima

Tarikh
:

KUMPULAN WANG SIMPANAN PEKER.JA


1 OGOS 2001

Tarikh

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991


PEMBERITAHUAN PENGELUARAN
50 TAHUN/55 TAHUN/DIVIDEN/KETIDAKUPAYAAN

KWSP 9B (AHL)
PERCUMA

PERHATIAN : MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATAU TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEMBERIKAN APA-APA DOKUMEN PAl.SU
DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MF.LAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BO1.EH DIDENDA ATAU DIPENJARA ATAU KEDUA-DUANYA

KEGUNAAN KWSP SAHAJA

SILATANDAKAN (V) Dl KOTAK YANG BERKENAAN

50 TAHUN

2 | 55TAHUN

DIVIDEN

4 I KETIDAKUPAYAAN

1. JEMS
PENGELUARAN

UNTUKPENGELUARAN55TAHUN:
SEKIRANYA AHLI MASIH BEKERJA DAN INGIN TERUS
MENCARUM, TANDAKAN
(V) Dl RUANGAN BERKENAAN
INGIN TERUS MENCARUM YA (
) TIDAK {
j . JIKAYA,
SILA ISiKAN BORANG KWSP 20 {AHL) DAN KWSP 20A [AHL)
UNTUK PENGELUARAN PENUH :
ADAPEMINDAHAN PELABURAN. YA(
} TIDAK',
)

BUTIRAN AHLI
2. NOMBOR AHLI

3. NOMBOR KAD PENGENALAN 12 DIGIT

KREDIT KE AKAUN BANK

4. NOMBOR KAD PENGENALAN 7 DIGIT


JENISAKAUN
1

AL-WADIAH

EEUD

r r

5. NOMBOR POUS/TENTERA/PASPORT/DSB

__

KONVENSIONAL

LJL

6. NAMA MENGIKUT KAD PENGENALAN/PASPORT

imnmu-immrnm

STATUS AKAUN AHLI

7. KETURUNAN

cmnmujjjjjjjmnmni]

AKTIF
TUTUP

8. TARIKri LAHIR

(UNTUK PENGELUARAN D2-5)

9. JANTINA

10. SEKTOR PEKERJAAN

LELAKI
PEREMPUAN

PENERIMA BAYARAN

BEKERJA SENDIRI

SWASTA

KERAJAAN

TIDAK BEKERJA

AHLI
PENJAGA

rm
TUT

r r Hi..

OISEHAKOLEH :
Pf.GAWAIPENYEMAK

POSKOD

BANDAR

mr
CAW

11. ALAMATAHLI

mm:

(UNTUK PENGELUARAN D2-6)

~T

mi

i|

in

NEGERI

UNIT

n
13. JENIS PEMBAYARAN

12. NOMBOR TELEFON PEJABAT

NO. K/TGN

D"

IIL:

NOMBOR FELEFON RUMAH/BIMBIT

IZLTTTEEITT]

TARIKH :...

WARAN

ARAHAN BAYARAN

ORAF BANK ASING

KREDIT KE AKAUN BANK

BUTIRAN AKAUN BANK

OISAHKANOLEH :
PEGAWAIPENGESAH

16. JENISAKAUN
14. KOD BANK

i5. NOMBOR AKAUN BANK

XD

nmmm

KONVENSIONAL
AL-WADIAH

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991.
17.
JENIS PENGELUARAN

TARIKH
DILULUSKAN OLEH :
PEGAWAI PELULUS1

NOMBOR AHLI

NOMBOR K/P

KIRI
CAP IBU JARI KIRI DAN
KANAN AHLI
(MESTI DITURUNKAN DENGAN
TERANG DAN PENUH
MENGGUNAKANPAD
CAP IBU JARI BERWARNA
HITAM)

TARIKH

TARIKH :

PEGAWAI PELULUS 2

NO. K/TGN

LIITTIIIJ
TARIKH :

KANAN

j
|

i
|
I

PANDUAN UNTUK MENGIS! BORANG KWSP 9B (AHL)


PEMBERITAHUAN PENGELUARAN 50 TAHUN / 55 TAHUN / DIVIDEN / KETIDAKUPAYAAN
SILA BACA PANDUAN INI DENGAN TELITI SFBELUM MENGISI BORANG. BORANG PERMQHQNAN MESTILAH DIPENUHKAN DENGAN HURUF
BESAR.

1.

Jenis Pengeluaran
Siia tanda (V) dalam petak yang berkenaan Jika tuan/puan memohon pengeluaran 50 Tahun, tandakan (V) seperti di bawah

1. JENIS
PENGELUARAN

i_3_

50 TAHUN

55 TAHUN

DIVIDEN

KETIDAKUPAYAAN

Untuk Pengeluaran 55 Tahun


Sekiranya ahli masih bekerja dan mgin terus mencaoim, sila tandakan (V) di ruangan yang berkenaan.
INGIN TERUS MENCARUM

( V ) YA

) TIDAK

Untuk Pengeluaran Penuh


ADA PEMlNDAHAN PELABURAN, YA ( V )

TIDAK (

Nombpr Ahli
Isikan satu digit di setiao ruang dengan didahului oleh digit '0' jika perlu, seperti contoh di bawah:
Contoh : 1234567
2. NOMBORAHLI
0

3.

Nombor Kad Pengenalan 12 Digit Ahli


Isikan nombor Kad Pengenalan 12 digit tuan/puan Jika tuan/puan belum memiliki Kad Pengenalan 12 digit, kosongkan ruangan
ini:
Contoh : 460701-02-6157

3. NOMBOR KAD PENGENALAN 12 DIGIT


0

Nombor Kad Pengenalan 7 Digit


Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah
4. NOMBOR KAD PENGENALAN 7 DIGIT

a)

1234567

b)

A 1234567

L7 .LL

g
^

5.

c)

K1234567

d)

H1234567

Nombor Polis/Tentera/Pasport/Dsb
Isikan Nombor Polis/Tentera/Pasport/Dsb, seperti contoh di bawah :
5. NOMLOR POLISffENTERA/PASPORT/DSB
a)

I 1234567

b)

T 1234567

'

1
1

Nama Mengikut Kad Pengenalan/Pasport


Tuliskan nama tuan/puan sebagaimana yang tercatat dalam kad pengenalan. Jika nama mengikut kad pengenalan ialah Norman
bin Abdullah, sila tuliskan nama seperti di bawah;

6. NAMA MENGIKUT KAD PENGENALAN/PASPORT


N 0 R M A N
B JJ N
A B D U L L A H
i

Keturunan
Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, isikan seperti di bawah:
7. KETURUNAN

1
1
2
3
4

Melayu
Cina
India
Lain-lain

Bidayuh
Kadazan
Iban

Tarikh Lahir
Isikan tarikh lahir tuan/puan mengikut susunan hari, bulan dan tahun. Jika tarikh lahii tuan/puan pada 1 Julai 1946, isikan seperti di
bawah:
8. TARIKH LAHIR

Jantina
Tandakan jantina tuan/puan dengan (S) dalam ruang yang disediakan. Jika lelaki, tandakan ( V ) di ruang yang berkenaan seperti
di bawah:
9. JANTINA
LELAKI
PEREMPUAN

10.

Sektor Pekeriaan
Tandakan (</) dalam ruang yang disediakan. Jika tuan/puan bekerja dalam sektor swasta, tanda (S) dalam ruang yang berkenaan
seperti di bawah:
10. SEKTOR PEKERJAAN

11.

BEKERJA SENDIRI

SWASTA

KERAJAAN

TIDAK BEKERJA

Alamat Ahli
Tuliskan alamat surat menyurat tuan/puan dengan lengkap. Jika alamat surat menyurat tuan/puan adalah Lot 10, Kg Parrt Kadir
Timur Bukit Pasir, 84300 Muar, Johor Darul Takzim, sila penuhi seperti berikut:

11. ALAMAT AHLI

"of

TK

|T

R I ] BI U

BANDAR

POSKOD

I'

NEGERI

I'
12.

Nombor Telefon
Isikan nombor telefon di ruangan yang disediakan di bawah.
Contoh : Nombor Telefon Pejabat: 07-9859450 dan Nombor Telefon Rumah/Bi.-nbit

016-2070158

12. NOMBOR TELEFON PEJABAT

sT7T4

NOMBOR TtLEFON RUMAH/BiWBIT

lil
13.

? J 0 |7 [0

|.

Jenis Pembavaran
Jika tuan/puan memilih cara pembayaran kredit ke akaun bank, tanda (S) di ruang yang berkenaan seperti di bawah .
13. JENIS PEMBAYARAN
WARAN

DRAFBANKASING

LARAHAN BAYARAN
I KREDIT KE AKAUN BANK

14.

KodJank
isikan nombor kod bank di ruangan yang disediakan seperti di bawah
Jika kod bank tuan/puan adalah Maybank
14. KOD BANK

rz

RHB Bank
Maybank
Bumiputra Commerce
Public Bank
Hong Leong Bank
Hong Leong Finance
Affin Bank
EON Bank
15.

01
02
03
04
05
06
07
08

Arab Malaysian Bank


Alliance Bank
Southern Bank
Utama Bank
Bank Muamalat
Arab Malaysian Finance
Bank Islam

Nombor Akaun Bank


Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah
15. NOMBOR AKAUN BANK
1

16.

Jenis Akaqn
Jika akaun tuan/puan adalah jenis konvpnsional, tanda (*Q di ruang yang berkenaan seperti di bawah
16. JENIS AKAUN

KONVENSIONAL
AL-WADIAH

17.

Jenis Pengeluaran, Nombor Ahli. Nombor Kad Pengenalan dan Cap Ibu Jari
Isikan jenis pengeluaran, nombor ahl' dan nombor kad pengenalan serta turunkan cap ibu jari kin dan kanan tuan/puan
dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam

09
10
11
12
13
14
15

KUMPULAN WANG SIMPANAN PEKERJA


EMPLOYEES PROVIDENT FUND
SENARAI SEMAKAN SKIM PENGELUARAN MENINGGALKAN NEGARA
LEAVING COUNTRY WITHDRAWAL CHECKLIST
Nama Ahli
Member's Name
No Ahli
Member's No

Tel (P)
Tel(O)

(R)
(R)

No Pasport
Passport No

10

PENTING
IMPORTANT
1 1

Sekiranya permohonan diserahkan di kaunter KWSP sila kemukakan clokumen asal beserta salmannya untuk
tujuan pengesahan oleh Pegawai KWSP
When submitting the application form at the counter please produce ongmal documen's together with the photostate copies of the document
for the purpose of certification by EPF officers

" ?

bekiranya tuan/puan mengemukakan salinan dokumen sahaja sila pastikan semua saiman dokumen telah disahkan oieh
majikan tuan/puan dtau pegawai yang dibenarkan oleh KWSP seperti benkul lengkap dengan nama d a i cop rasmi
pengesah When submitting photostate documents please ensure that photostate copies of all the documents are certified true copy by vcur e 7)o/o> er or
authorized officers as follows complete with the name and official stamp of the officer concerned
1 21

Pegawai KWSP EPF Officer


Pegawai KWSP (Gred 18 ke ata)
EPF Officer (Grade 18 and Above) '
Pegawai Kaunter KWSP
EPF Counter Officer

122

Pegawai Kedutaan Malaysia


Malaysian Embassy Officer

' 23

Notan Awam
Public Notary

13

Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwdrna hjldDl Tuan/puan hendaklah menurunkan cap
bu jan kin dan xanan de^iqan terang dan penuh menggunakan Pad Cap Ibu Jan bciyvarna hjtam.
Ldch withdrawal form must be completed using bjsoi ink pa Members must a/so affix higher nght and left thumbpnnt cleiriy and in lull
using black ink thumbpnnt psd

14

Tuan/puan henolakldh rr^mastikdn dokumen dokunen yang disertakan beibama sama dengan borang oermohonan
DIKLIPKAN dan tidak menggunakan dawai kokot (staples)
Please ensure that all documents forwarded togethei with the apulicatior form are CLIPPER md not stappled

15

Semua salinan fotostat dokumen hendaklah me iggunakin kertas saiz A4


All photostate cop'es of documents must be on A4 sue papr

16

KWSP berhak menolak mana manu permohoPcn yang idak lengkap


EPF reserves the ngh1 to 'eject incomplete application

20

DOKUMEN UTAMA
MAIN DOCUMENTS
Tandakan (V) dalam kotak yang berkenaan
Please tick (V) in the box where applicable

3.0

21

Borang Permohonan KWSP 9B (AHL) - 2 salinan

22

Borang KWSP 3A (AHL) - 1 salinan


Form KWSP 3A (AHL.) -1 copy

23

Salman muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan atau
Penyata Akaun Bank Semasa yang asal Pemohon hendaklah menurunkan cap ibu jan kin dan
kanan di atas salinan tersebut Sekiranya tuan/puan menghantar melalui pos, salinan dokumen
hendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, sila
kemukakan dokumen asal beserta sahnannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSP
Photostate copy of the front page of your bank book with details of your bank account number ox the original
copy of your current Account Bank Statement Applicants are required to affix left and right thumb print impression
on copies of the document Please forward the ongmal document together with a photostate copy to be certified
by the EPF Counter Officers at the counter Photostate copy of the bank book mus< be cenified true copy by the
respective bank's officer if submission ii through post

PEGAWAI DAGANG
EXPATRIATE
31

Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport
(Sila serahkan salinan pasport yang lama sekiranya nombor pasport terkini berbeza denqan rekod KWSP)
Photostate copy of valid passport stating clearly your name and passport number
(Please forward photostate copy of old passport if current passport number differs from EPF records)

32

Bukti penamatan kerja


Proof of resignation/tenmnption of contract
- Surat penamatan kontrak oleh majikan
Acceptance of resignation/termination of contract by employer
ATAU
OR
- Penyata Perlepasan Cukai Pendapatan
Income tax clearance lefer

4.0

50

33

Pembatalan permit kerja (Tidak malebihi 3 bulan dan tankh permohonan)


Cancellation of work permit
(Not exceeding 3 months from the date of application)

34

Sila bekalkan alamat ahli di luar negara


Please give your overseas correspondence address

BEKAS WARGANEGARA MALAYSIA


rAYSIAN CITIZEN
4 1

Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport
Photostate copy of valid passport stating clearly your name and passport number

42

Surat Penyerahan Kad Pengenalan dan Pelucutan Kewarganegaraan danpada Pejabat Pendaftaran Negara
Letter of surrendenng of the Identity Card and renounciation of citizenship from the Registration Office

43

Sila bekalkan alamat ahli di luar negara


Please give your overseas correspondence address

PEKERJA ASING
FOREIGN WORKER
51

Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport
(Sila kemukakan salinan pasport yang lama sekiranya nombor pasport terkini berbeza dengan rekod KWSP)
Photostate copy of valid passport stating clearly your name and passport number
(Pleaseforwardphotostate copy of old passport if current passport number differs from EPF recoros)

52

Sila bekalkan alamat ahli di luai negara


Please give your overseas correspondence address

60

DOKUMENTAMBAHAN
ADDITIONAL DOCUMENT
61

SIJII Perkahwinan
(Sekiranya nama di dalam pasport berlainan dengan rekod KWSP)
Marriage Certificate
(If name in the passport aiffers from EPF records)

Tandatangan Ahli
Veinbf" > Signature

Tankh
Date

Tandatangan Penenma
Rf teiver s Signature

Tankh
Date

KUMPULAN WANG SIMPANAN PEKERJA


1 O&OS 2001

KWSP 96 (AHL)
PERCUMA

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991


PEMBERITAHUAN PENGELUARAN
MENINGGALKAN NEGARA

PERHATIAN MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATAU TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEM6ERIKAN APA-APA
IOKUMEN PALSU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MELAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BOLEH DIDENOA ATAU DIPENJARA ATAU
DUA-DUANYA
ATTENTION
ANY PERSON WHO MAKES ANY UNTRUE OR FALSE STATEMEN1S OR PRODUCES ANY FALSE DOCUMENTS REGARDING ANY MATERIAL PARTICUtARS IS COMMITTING AN OFFENCE ANO IF FOimO GUL TY
SHALL BF LIABLE TO 'MPRISONMENT OR FINE OR BOTH

KEGUNAAN KWSP SAHAJA


FOR EPF USE ONLY

BUTIRANAHLI
PARTICUIARS OF MEMBER

KP
DC

nxo

1 NOMBORAHU

2 NOMBOR KAD PENGENALAN 12 DIGIT

MtMBERS NUMBER

<1 DIGIT IDENTITY CARD NUMBER

OUT

3. NOMBOR KAD PENGENALAN 7 DIGIT

4 NOMBOR POLIS/TENTERA/PASPORT/DSB

7 DIGI1 IDENTITY CARD NUMBER

nxxxixx

POLICEMUTARY/PASSPORTNUMBER/ETC

MOD PEMBAYARAN
MODE OF PAYMEN1

WARAN

5 NAMA MENGIKUT KAD PENGENALAN/PASPORT

6 KETURUNAN

Nl^MF AS PER THE APPLICANTS IDENTITY CARD/PASSPORT

RACE

WARRANT

ORAFBANKAS'NG
FORE'GN BANK DRAFT

APAHAN BAYARAN
] tW'KWlFSS
P K R F D I T K E AKAUN BANK

j c M b AKAUN

DIRECCREDITING

ARIKHL/HIR

I J\N1INA

DATEOF8IR~H

9 SEKTOR PEKERJAAN

GENDER

T
V

EMPLOYMENT SECTOR

SWASTA

MALE

BCKERJASENDIRi
i f ( . f EMPLOYED

PRIVATE

PEREMPUAN

KERAJAAN

TIDAK BEKERJA

FEMALE

GOVERNMENT

UNEMPLOYED

LELAKI

YPE OF ACCOUN1

KONVtNSIONA
I CONVENTIONAL

[ ALWADIAH
L ALWADIAH
10 ALAMATArlU
MEMBER S ADDRESS

DISEMAK OLEH
PEGAWAI PENYEMAK
CHECKED BY OFFICER IN CHARGE

POSKOD

BANDAR

POSTCODE

CITY

NEGERI
STATE

nzninzinin "i_ nzn :n _ m


12 JENIS PEMBAYARAN
DPC OF PAYMENT

11 NOMBOR TEL EF ON PEJABAT

rrxx

OFHCt IELEPHO'IE NUMBER


vVARAN
WARRANT

NOMBOR IFLEFON RUMAH


'ESIDlNCEJTLEPHONEI

ARAHAN BAYARAN
WARRANTLESS

DRAFBANKASINC

KREDIT KE AKAUN BANK

FOREIGN BANK DRAF i

DIRECT CREDITING

UMBER/HANWHONE

J LJ
BUTIRAN AKAUN BANK
PAPTICULARS

IAWKH
OATt

13 KODBANK

14 NOMBOR AKAUN BANK

BANK CODE

BANKAt^OLNlNbMbER

15 JENbAKALN
TYPE OF ACCOUM

KONVENSIONAL
CONVENTIONAL
AL WADIAH
AL WADIAH

OFBANKACK-OUNI

xixixxLxn

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991.
/ HEREBY APPLY TO WITHDRAW VY EPF CREDIT IN ACCORDANCE WITH THE EPF ACT 13S1

16.
JENIS
PENGELUARAN
TYPE OF
WITHDRAWAL
NOMBORAHLI

MEMBER'S NUMBER

PEMBERITAHUAN :
OISAHKAN OLEH:
PEGAWAI PENGESAH

CAP IBU JARI KIR! DAN


KANAN AHLI
(MESTI DITURUNKAN DENGAN
TERANG DAN PENUH
MENGGUNAKAN PAD
CAP IBU JARI BERWARNA
HITAM1

NOTIFICATION
VERIFIED BY
OFFICER IN-CHARGE

HH
H

jgjjj

NOMBOR K/P
IDENTITY CARD

NUMBER

Klfil

mm

LEEI

BlSiU

LEFT AND RIGHT THUMB IMPRESSION


OF THE MEMBER
(MUST BE CLEARLY AND FULL Y
AFFIXED USING BLACK INK
THUMBPRINT PAD)

NO K/TGN
STAFF REF NO

TARIKH
DATE

TARIKH
DATE

17. AKUAN SAKSI


WITNESS DECIMATION
"SAYA DENGAN INI MENGAKU DAN MENGESAHKAN BAHAWA BUTIR-BUTIR PEMOHON TERCATAT Dl ATAS ADALAH MENGIKUT KAD
PENGENALAN MALAYSIA / SINGAPURA / POLIS / TENTERA / PASPORT YANG SAVA TELAH PERIKSA SENDIRI DAN PEMOHON TELAH
MENURUNKAN CAP IBU JARI KIRI DAN KANANNYA Dl HADAPAN SAYA"
DILULUSKAN OLEH :
PEGAWAI PELULUS 1
APPROVED By
APPROVAL OFFICER 1

POLICE I MILITARY IDENTITY CARD I PASSPORT THAT I HAVE PERSONALLY EXAMINED AND THAT HE I SHE HAS DULY AFFIXED HIS I HER LEFT AND RIGHT
THUMB IMPRESSION BEFORE ME '

NAMA PENUH SAKSI


FULL NAME OP WITNESS

NO KAD PENGENALAN SAKSI


IDENTITY CARD NO OF WITNESS

ALAMAT SAKSI

NO K/TGN
STAFF REF NO

ADDRESS OF WITNESS

TANDATANGAN SAKSI
SIGNATURE Of WITNESS

JAWATAN DAN COP RASMI

TARIKH

DESIGNATION AND OFFICIAL STAMP

DATE

TARIKH
DATE

NOTA ;

ttSSE
BERIKUT ADALAH SENARAI ORANG YANG BOLEH MENJADI SAKSI
THE FOLLOWING PERSONS MAY ACT AS A WITNESS

PEGAWAI KWSP YANG TERDIRI DARIPADA

EPF OFFICER

PEGAWAI PELULUS 2
APPROVAL OFFICER 1

PEGAWAI KWSP GRED 18 KE ATAS

PEGAWAI KAUNTER KWSP

NO K/TGN

TARIKH
DATS

PEGAWAI KEDUTAAN MALAYSIA


MALAYSIAN EMBASSY OFFICER

EPF OFFICER GRADE (8 AND ABOVE

EPF COUNTER OFFICER

STAFF REF NO

MAJIKAN PEMOHON
APPLICANTS EMPLOYER

NOTARIAWAM
PUBLIC NOTARY

PANDUAN UNTUK MENGISI BORANG KWSP 9B (AHL)


PEMBERITAHUAN PENGELUARAN MENINGGALKAN NEGARA
GUIDELINES TO COMPLETE FORM KWSP 9B(AHL)
LEAVING COUNTRY WITHDRAWAL
SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAH DIPENUHI
DENGAN HURUF BESAR.
PLEASE READ THESE GUIDELINES CAREFULLY BEFORE COMPLETING THE FORM. THE FORM MUST BE COMPLETED IN BLOCK LETTERS.
1

Nombor Ahli
Member Number

Isikan satu digit di setiap ruang dengan di dahului oleh digit '0' jika perlu, seperti contoh di bawah
Fill in the space with one number, starting with '0' as shown below
Contoh . 1234567
Example 1234567
1. NOMBOR AHLI
MEMBER'S NUMBER

KadPenaenalan 12 Diqit

Nombo

12-Diait Identitv Card Number

Isikan nombor Kad Pengenaian 12 digit tuan/puan Jika tuan/puan belum memiliki Kad Pengenalan 12 digit, kosongkan
ruangan mi
Fill in your 12-digit Identity Card number Leave this space blank if you do not have any
Contoh 610701-02-6157
Example 610701-02-6157
2. NOMBOR KAD PENGENALAN 12 DIGIT
12 DIGIT IDENTITY CARD NUMBER

Nombor Kad Pengenalan 7 Digit / Polis/ Tentera/ Pasport / Dsb


7-Digit Identity Card / Police/ Military/ Passport Number/ Etc
Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah
Fill m /our 7-digit Identity Card number,mcluding the initial as shown below
3. NOMBOR KAD ^ENGENALAN 7 DIGIT
7 DIGIT IDENTITY CARD NUMBER

4.

a)

1234567

h)

A1234567

c)

K1234567

d)

H1234567

Nombor Polis/Tentera/Pasport/Dsb
Police/Military/Passport Number/Etc
Isikan Nombor Polis/Tentera/Pasport/Etc termasuk huruf awalan, seperti contoh di bawah
Fill in your police/military'/passport number/etc, including the mtial as shown below
4. NOMBOR POLISH TNTERA/PASPORT/DSB
POLICE/MILITARY/PASSPORT NUMBER/ETC
a)

I 1234567

b)

T 1234567

Nama Mengikut Kad


Name As Registered In Identity Card I Passport
Tuliskan nama tuan/puan sebagaiinana yang tercatat dalam kad pengenalan tuan/puan Jika nama mengikut kad penqenalan
lalah Norman bin Abdullah sha tuliskan nama seperti di bawah
Write your name as registered in your identity card If your name as per your identity card is Norman bin Abdullah, please
complete your name as follows
NAMA MENGIKUT KAD PENGENALAN / PASPORT
NAME AS PER IDENTITY CARD / PASSPORT

!
Keturunan

Isikan ruang dengan mengikut kod keturunan di bawah mi Jika tuan/puan berketurunan Melayu, isikan seperti di bawah
Please complete this portion with rpference to the following For instance ifyou are a Malay
6. KETURUNAN
RACE

Melayu
Malay

Bidayuh
Bidayuh

Cina
Chinese

Kadazan
Kadazan

India
Indian

Iban
Iban

Lam-lam

Others

Tarikh Lahir
Date of Birth
Isikan tankh lahir tuan/puan mengikut susunan han, bulan dan tahun Jika tankh lahir tuan/puan pada 1 Julai 1961, isikan seperti di bawah
Fill in your date of birth accordingtothe date, month and year If your date of birth is 1 July 1361, please fill in as follows

7 TARIKH LAHIR
DATE OF BIRTH

H H

B B T T

D D

M M Y Y

0 1

Jantina
gender
Tandakan jantina tuan/puan dengan [/) dalam ruang yang disediakan

Jika lelaki, tandakan {/) di ruang yang berkenaan

seperti di bawah
Please tick{S) whichever is applicable Ifyou are a male, please fill in as follows
8. JANTINA
GENDER
LELAKI
MALE
PEREMUAN
FEMALE

9.

Sektor Pekerjaan Ahli


Employment Sector
Tandakan {/) dalam ruang yang disediakan JiKa tuan/puan bekerja dalam seklor swasta, tanda (V) dalam ruang yang
berkenaan seperti di bawah
Please tick {/) whichever is applicable If you are working in the pnvate sector, please fill in as follows

9. SEKTOR PEKERJAAN
EMPLOYMENT SECTOR
BEKERJA SENDIRI
SELF EMPLOYED
KERAJAAN
GOVERNMENT

10.

SWASTA
PRIVATE
TIDAK BEKERJA
UNEMPLOYED

AlamatAhli
Member's Address

Tuliskan aiamat surat menyyat tuan/puan dengan lengkap Jika alamat surat menyurat tuan/puan adalah Lot 10, Kg Pant
Kadir rmiur, Bukit Pasir, 84300 Muar, Johor Darul Takzim, sila penuhi seperti Derikut
Please complete yow full address If your address is Lot 10, Kg Pant Kadir Timur, Bukit Pasir, 84300 Muar, Johor Darul Takzim
please fill in as follows
10. ALAMAT AHLI
MEMBER'S ADDRESS

PA

II

M|U
I

iS I U

[R
I

POSKOD

K
I

I [ M
I

[ P IA | S 1
I

L _J

__i

BANDAR
CITY

POSTCODE

NEGERI
STATE

[7
11.

O I R

Nombor Telefon Ahli


Member's Telephone Number
Isikan nombor telefon di ruangan yang disediakan di bawah
Contoh
Nombor Telefon Pejabat 07 9859450 dan Nombor Telefon Rumah/Bimbit 016-2070158
Please complete your telephone number (if any) as follows
For example Office Telephone Number 07 9859450 and Residence Telephone Number I Handphone 016 - 2070158

11. NOMBOR TELEFON PEJABAT


OFFICE TELEPHONE NUMBER

NO TELEFON RUMAH/BIMBIT
RESIDENCE TELEPHONE NUMBER /HANDPHONE

12.

Jenis Pembayaran
Type Of Payment
Jika tuan/puan memilih kaedah pembayaran kredit ke akaun bank, tanda ( / ) di ruang yang berkenaan seperti di bawah :
If you choose direct crediting, pleas$ tick ( ) as below:
12. JENIS PEMBAYARAN
TYPE OF PAYMENT
WARAN
ARAHAN BAYARAN
WARRANT
WARRANTLESS
DRAFBANKASING
KREDIT KE AKAUN
FOREIGN BANK
BANK
DRAFT
DIRECT CREDITING

13.

KalBank
Bqnl{ Code
Isikan nombor kod bank di ruangan yang disediakan seperti di bawah :
Please fill in the bank code number in the space below:
13. KOD BANK
BANK CODE

Nama Bank
Name of Bank
RHB Bank
Maybank
Bumiputra Commerce
Public Bank
Hong Leong Bank
Hong Leong Finance
Affin Bank
EON Bank

14.

Kod

Nama Bank

Kod

Code

Name of Bank

Code

01
02
03
04
05
06
07
08

Arab Malaysian Bank


Alliance Bank
Southern Bank
Utama Bank
Bank Muamalat
Arab Malaysian Finance
Bank Islam

09
10
11
12
13
14
15

Nombor Akaun Bank


Bank Account's Number
Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah:
If your bank account's number is 1-23456-789012-3, please fill in as below:

15.

Jenis Akaun
Type of Account
Jika akaun tuan/puan adalah jenis konvensional, tanda ( V ) di ruang yang berkenaan seperti di bawah:
Please tick (</) as below, if your type of account is conventional:
KONVENSIONAL
CONVENTIONAL

AL-WADIAH
AL-WADIAH

16.

Jenis Pengeluaran, Nombor Ahli, Nombor Kad Pengenalan dan Cap Ibu Jari
Type of Withdrawal. Membership Number. Identity Card Number and Thumb Impression
Isikan jenis pengeluaran, nombor ahli dan nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan tuan/puan dengan
terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.
Kindly fill in type of withdrawal, membership number, identity card number and left and right thumb impression. The impression
must be clear and fully affixed using black ink thumbprint pad.

17.

Afcuan Sakal
Witness Declaration
Senarai orang yang boleh menjadi saksi adalah seperti berikut:
The following persons may act as a Witness:
1.

2.

PegawaiKWSPterdiridaripada:
EPF Officer

Pegawai KWSP Gred 18 Ke atas


EPF Officer Grade 18 and above

Pegawai Kaunter KWSP


EPF Counter Officer

Majikan Pemohon
Applicant's Employer

3.

Pegawai Kedutaan Malaysia


Malaysian Embassy Officer

4.

Notari Awam
Public Notary