| 1. SYEIKH |
i. Nama ...................................................................................
ii. No. Kad Pengenalan ..........................................................
iii. Umur ...................................................................................
iv. Jantina ...................................................................................
v. Kewarganegaraan ................................................................
vi. Tarikh Lahir ...........................................................................
vii. Tempat Lahir ...........................................................................
viii. Alamat Tetap ..........................................................................
ix. Alamat Surat Menyurat .............................................................
x. No. Telefon ...............................................................................
xi. No. Faksimili .............................................................................
xii. E-mel ...................................................................................
xiii. Kelayakan Akademik ........................................................... |
| 2. ORANG YANG DIPERTANGGUNGJAWABKAN OLEH SYEIKH |
i. Nama ...................................................................................
ii. No. Kad Pengenalan ........................................................
iii. Umur ...................................................................................
iv. Jantina ...................................................................................
v. Kewarganegaraan ...............................................................
vi. Tarikh Lahir .......................................................................
vii. Tempat Lahir ........................................................................
viii. Alamat Tetap .......................................................................
ix. Alamat Surat Menyurat ..........................................................
x. No. Telefon ............................................................................
xi. No. Faksimili ...........................................................................
xii. E-mel ...................................................................................
xiii. Kelayakan Akademik ........................................................... |
| 3. NAMA TAREKAT TASAWUF |
|
| 4. SILSILAH TAREKAT TASAWUF |
|
| 5. PUSAT PENGAMALAN TAREKAT TASAWUF |
i. Alamat ...............................................
ii. No. Telefon ................................................ |
| 6. STRUKTUR ORGANISASI |
|
| 7. BENTUK AMALAN ZIKIR |
|
| 8. DOKUMEN-DOKUMEN LAIN |
|
| 9. MAKLUMAT TAMBAHAN |
|
| 10. PENGAKUAN |
Saya .......................................................... No. K.P. ............................................
dengan ini mengaku bahawa segala maklumat yang diberikan adalah benar.
| Tandatangan................. | Tarikh: ................... |
|
| UNTUK KEGUNAAN PEJABAT |
Ulasan Pendaftar
| Tandatangan................. | Tarikh: ................... |
|