SEKOLAH KEBANGSAAN LA SALLE

JALAN GASING, 46000 PETALING JAYA

SELANGOR DARUL EHSAN
KOD SEK : BBB 8306 NO. TEL : 03-79567536 NO. FAX : 03-79563505

BORANG ADUAN

NAMA PENGADU : ____________________________________________________

NO. KAD PENGENALAN : ____________________________________________________
ALAMAT RUMAH : ____________________________________________________
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NO. TEL. BIMBIT : ____________________________________________________
TARIKH ADUAN : ____________________ MASA ADUAN : __________________
NAMA ANAK : ____________________________________________________
KELAS : ____________________________________________________

BUTIRAN ADUAN : ____________________________________________________

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TANDATANGAN PENGADU : ………………………………….. …………………….

Tandatangan Pengawal

TINDAKAN YANG DIAMBIL : ____________________________________________________

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Tandatangan G. Besar / PK / PP / Guru