JADUAL (PERATURAN-PERATURAN PENGAWASAN PENGAJARAN DAN SYARAHAN AGAMA 2013

Pk. P.U. 10/2013
PERATURAN-PERATURAN PENGAWASAN PENGAJARAN DAN SYARAHAN AGAMA 2013

JADUAL

JADUAL

PERATURAN-PERATURAN PENGAWASAN PENGAJARAN DAN SYARAHAN AGAMA 2013

BORANG TM I

MAJLIS AGAMA ISLAM DAN ‘ADAT MELAYU PERAK PERMOHONAN TAULIAH MENGAJAR
[peraturan 3]

Kepada
Pengerusi Jawatankuasa Pengawasan Pengajaran Agama Islam
Negeri Perak Darul Ridzuan
Tkt. 5, Kompleks Islam
Jalan Panglima Bukit GantangWahab
30000 Ipoh

Dengan hormatnya saya memohon Tauliah Mengajar di Negeri Perak dan butir-butir diri saya adalah seperti yang berikut:

Nama Penuh : ........................................................................................................................................................................................................

No. Kad Pengenalan : ...........................................................................................................................................................................................

* No. Pasport dan tamat tempoh : ......................................................................................................................................................................

* No. Visa dan tamat tempoh : ............................................................................................................................................................................

* No. Pas Profesional dan tamat tempoh : ........................................................................................................................................................

Alamat : .....................................................................................................................................................................................................................

No. Tel. : ...................................................................................................................................................................................................................

Tarikh Lahir : ............................................................................................................................................................................................................

Tempat dilahirkan : .................................................................................................................................................................................................

Kelulusan/Tempat

Mempelajari ilmu/

Nama Guru : ..................................................................................................................................................................................................................

Ilmu/Bidang yang dipelajari : .......................................................................................................................................................................................
Ijazah/Kelulusan/
Sijil/Syahadah/

Surat Akuan : ....................................................................................................................................................................................................................

Ilmu/Bidang yang hendak diajar : ..................................................................................................................................................................................

Tempat yang dicadangkan untuk mengajar : ..............................................................................................................................................................

Pengalaman : .......................................................................................................................................................................................................................

Saya dengan ini mengaku bahawa segala keterangan yang tersebut di atas adalah benar.

Tandatangan Pemohon : ................................................................................................ Tarikh : .....................................................................................

* Untuk diisi oleh pemohon bukan warganegara.

Ulasan Pegawai Tadbir Agama Daerah :

Tandatangan : ................................................................................................................... Tarikh : .....................................................................................

Untuk Kegunaan Pejabat:

Borang permohonan diterima pada ...................................................................................................................................................................................

Permohonan diterima/ditolak (alasan jika ada) :
....................................................................................................................................................................................................................................................
....................................................................................................................................................................................................................................................
....................................................................................................................................................................................................................................................

Ujian bertulis/lisan pada ......................................................................................................................................................................................................

Tempat : ..................................................................................................................................................................................................................................

Keputusan : LULUS / GAGAL

PERATURAN-PERATURAN PENGAWASAN PENGAJARAN DAN SYARAHAN AGAMA 2013

BORANG TM II

MAJLIS AGAMA ISLAM DAN ‘ADAT MELAYU PERAK TAULIAH MENGAJAR AGAMA
[peraturan 6]

Bahawasanya MajlisAgama Islam dan ‘Adat Melayu Perak dengan ini mengurniakan Tauliah ini kepada ........................................................................................................ No. Kad Pengenalan/No. Pasport ................................................................................................ beralamat ..................................................................................................................................................
................................................................................................................................................................................................ untuk mengajar Agama Islam di Negeri Perak Darul Ridzuan.

Mudah-mudahan Allah memberi taufiq dan hidayah kepada anda bagi meninggikan syiar Islam di negeri ini. Amin Ya Rabbal ‘Alamin.

Tarikh : ...............................................................................................................................
Bersamaan : ....................................................................................................................

Yang Dipertua,
Majlis Agama Islam dan ‘Adat Melayu
Perak Darul Ridzuan

PERATURAN-PERATURAN PENGAWASAN PENGAJARAN DAN SYARAHAN AGAMA 2013

BORANG S I

MAJLIS AGAMA ISLAM DAN ‘ADAT MELAYU PERAK PERMOHONAN KEBENARAN UNTUK MENGANJURKAN DAN MEMBERI SYARAHAN AGAMA
[peraturan 11 dan 17]

Pegawai Tadbir Agama,
Daerah ....................................................................................

Tuan,

Saya/Kami memohon kebenaran untuk menganjurkan/memberi suatu syarahan agama dan keterangan berkenaannya adalah seperti yang berikut:

1. *Nama Penganjur : ...................................................................................................................................................................................................................................

2. Nama Pegawai yang bertanggungjawab..............................................................................................................................................................................................

3. Alamat : .........................................................................................................................................................................................................................................................

4. Tempat Syarahan : ....................................................................................................................................................................................................................................
.
5. Tajuk Syarahan : .........................................................................................................................................................................................................................................

6. Tujuan Syarahan : ......................................................................................................................................................................................................................................

7. Tarikh Syarahan : ........................................................................................................................................................................................................................................

8. Maklumat Penceramah :

i. Nama : ....................................................................................................................................................................................................................................................

ii. Alamat & No. K/P : ................................................................................................................................................................................................................................

**No. Pasport dan tamat tempoh : .................................................................................................................................................................................................

**No. Visa dan tamat tempoh : ........................................................................................................................................................................................................

**No. Pas Profesional dan tamat tempoh : ...................................................................................................................................................................................

iii. Kelulusan : .....................................................................................................................................................................................................................................................

iv. Pekerjaan : ......................................................................................................................................................................................................................................................

v. Pengalaman : ...................................................................................................................................................................................................................................................

Sesungguhnya saya berikrar dan mengaku bahawa saya akan bertanggungjawab mematuhi Enakmen PentadbiranAgama Islam (Perak) 2004 dan Peraturan-Peraturan Pengawasan Pengajaran dan Syarahan Agama 2013 dan mengawal majlis itu supaya berjalan dengan aman dan sesuai dengan kehendak Agama Islam.

Tarikh : ..............................................

Tandatangan Pemohon (Penganjur)
dan cop rasmi

...........................................................

Tandatangan Pemohon (Penceramah)

........................................................

* Sekiranya penganjur ialah suatu pertubuhan atau badan, maka selain nama pertubuhan atau badan tersebut hendaklah juga dinamakan pegawai yang
bertanggungjawab bagi pertubuhan atau badan dan beliau hendaklah menandatangani sebagai pemohon (penganjur).

**Untuk diisi oleh pemohon bukan warganegara.

PERATURAN-PERATURAN PENGAWASAN PENGAJARAN DAN SYARAHAN AGAMA 2013

BORANG S II

MAJLIS AGAMA ISLAM DAN ‘ADAT MELAYU PERAK KEBENARAN UNTUK MENGANJURKAN ATAU MEMBERI SYARAHAN AGAMA
[peraturan 11 dan 17]

1. Bahawa
(Nama) ......................................................................................................................................................................................................................................

No. Kad Pengenalan ...............................................................................................................................................................................................................

Alamat ..........................................................................................................................................................................................................................................

......................................................................................................................................................................................................................................................

.......................................................................................................................................................................................................................................................

diberi kebenaran untuk menganjurkan/memberi syarahan agama pada/mulai..................... hari bulan .................................... tahun ................

hingga .....................................hari bulan ................... tahun .................................. pukul .............................. hingga pukul ..............................................

2. Penceramah ialah :
Nama : ............................................................................................................................................................................................................................................

Alamat : ...........................................................................................................................................................................................................................................

No. Kad Pengenalan : ..................................................................................................................................................................................................................

Jawatan : ..........................................................................................................................................................................................................................................

Tempat bertugas : ...........................................................................................................................................................................................................................

Tauliah atau perakuan lain (jika ada) :
..............................................................................................................................................................................................................................................................

...............................................................................................................................................................................................................................................................

Semoga tuan/puan dapat menjalankan tugas dengan baik bersesuaian dengan tuntutan ajaran agama Islam.

Tarikh : ........................................................................

Pegawai Tadbir Agama
Daerah ....................................................................
..................................................................................

Dibuat 14 Disember 2012
[MAIAMP(BP) A603/666/1 Jld. 2; PU.PK. 17/2007]

Dengan Titah Perintah Duli Yang Maha Mulia,

DATO' SERI DIRAJA DR. ZAMBRY BIN ABDUL KADIR
Menteri Besar
Perak Darul Ridzuan