Phg. P.U.12/1995
PEGUAM SYARIE REGULATIONS 1995
FORM D
(Subregulation 24(3))
APPLICATION FOR RENEWAL OF ANNUAL PRACTISING CERTIFICATE
To:
The Chairman of Peguam Syarie Committee.
With due respect I apply to renew may Annual Practising Certificate which has expired on the ...................... day of .................................... 19 ...............................
2. The relevant particulars are as follows:
(a) Name:
(b) Identity Card Number:
(c) Address:
(d) Registration Serial Number of Sijil Peguam Syarie:
(e) The expired Annual Practising Certificate Number:
3. I hereby affirm that I have never been taken any action against in respect of my profession as a Peguam Syarie.
4. I enclose herewith a fee of RM 50.00
Date........................
............................
Signature of Application
Made the 15th day of July 1993.
[M.U.I. Phg. 18/13.]
DATO' HAJI ABDUL MUTALLIB BIN HAJJ MOHO. ALl AL FAKWIE,
Timbalan Yang Dipertua,
Majlis Ugama Islam dan
Adat Resam Melayu Pahang
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