Sel. P.U. 14/2009
PERATURAN-PERATURAN PENDAFTARAN, PENJAGAAN DAN PENGAJARAN BAGI MUALLAF (NEGERI SELANGOR) 2009
JADUAL - Borang E
BORANG E
[Subperaturan 24(1)]
PERATURAN-PERATURAN PENDAFTARAN, PENJAGAAN DAN PENGAJARAN
BAGI MUALAF (NEGERI SELANGOR) 2009
PERMOHONAN PINDAAN BUTIRAN DIRI DALAM PERAKUAN MEMELUK
AGAMA ISLAM
Nama pemohon: .............................................................................................................................
No. Kad Pengenalan/Pasport: .....................................................................................................
Bilangan Daftar: ..............................................................................................................................
Kewarganegaraan: .........................................................................................................................
Alamat Surat Menyurat: ..................................................................................................................
.............................................................................................................................................................
Butiran pindaan:
Alasan memohon pindaan: .............................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
Saya mengaku bahawa maklumat yang saya berikan di dalam borang ini adalah benar.
| Tarikh: ………………………… | ...……….............…………..
Tandatangan Pemohon |
* Sila sertakan salinan Perakuan Memeluk Agama Islam yang asal
Dibuat 27 Mei 2009
[MAIS/PM/BUU/01-2/012/1; PU. Sel. Am 198/08/TS]
Dato’ Setia Haji Mohamm ad Adzib bin Mohd Isa
Pengerusi
Majlis Agama Islam Selangor
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