Form E (REGISTRATION OF ISLAMIC RELIGIOUS SCHOOLS (MALACCA) REGULATIONS 2003

M.P.U. 1/2003
REGISTRATION OF ISLAMIC RELIGIOUS SCHOOLS (MALACCA) REGULATIONS 2003

Form E

(Subparagraph 7(2))

APPLICATION TO CHANGE ADDRESS OF PREMISES OR TO ALTER THE PREMISE OF ISLAMIC RELIGIOUS SCHOOL

Registrar
Islamic Religious Schools
Islamic Religious Department of Malacca
Malacca

I respectfully forward an application to change the address of the premise/to alter the premise of the religious school the information of which are as stated below:

2. Attach herewith is the fee for the application as follows:

Bank Draft No: .................................................................................... Name of Bank : ........................................................................................ Address of Bank: ............................................................................

Yours faithfully,

...........................................
(Signature of Applicant)

Full name : .......................................................................................... Identification Card No. : ........................................................................ Designation: ........................................................................................... Dates: .....................................................................................

PART I - TO BE FILLED BY THE BOARD OF MANAGEMENT OF THE ISLAMIC RELIGIOUS SCHOOL

1. Name of Islamic Religious School: ....................................................................................................................................................................................................

2. Address: ..........................................................................................................................................................................Postcode: .............................. Telephone No: ...........................Facsimile No: .............................. E-Mail Address: .............................................................

3. Information regarding registration:

Certificate of Registration No: ..................................................... Date of registration: .........................................................................

4. Information regarding Chairman of Board of Management of Islamic Religious School:

Full name: .................................................................................. Identification Card/Passport No: ......................................................

PART II - IF THE APPLICATION IS FOR CHANGE OF ADDRESS OF PREMISE

5. New premise address: .................................................................................................................. Postcode: ....................................... Telephone No.: ...............................Facsimile No.: .......................... E-Mail address: .................................................................................

6. Information regarding premise:

7. Particulars on Rooms:

8. Particulars on Facilities/Equipments:

PART III - IF APPLICATION IS FOR ALTERATION OF PREMISE

Please tick (/) in appropriate box

PART IV - DECLARATION OF APPLICANT

I.............................................................................................................. Identification Card No...................................................................... do solemnly and sincerely declare that all statements contained in this application form and all documents attached herewith are true to the best of my knowledge and belief.

........................................
(Signature of Applicant)

Name:........................................................
Designation:...............................................
Date:...........................................................