BORANG KEAHLIAN

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BORANG KEAHLIAN

1. NAMA PENUH *

Tuliskan nama penuh dalam Huruf Besar (Full name of applicant in Capital Letter)

2. NO KAD PENGENALAN *

No. K/P baru 12 angka (N.R.I.C. No.)

3. WARGANEGARA *

Cth: Malaysia, Brunei, Indonesia, dll. (Nationality)

4. JANTINA *

(Sex)

Lelaki (Male)

Perempuan (Female)

5. TARIKH LAHIR *

(Date of birth)

YYYY

6. ALAMAT RUMAH *

(House address)

7. POSKOD *

(Poscode)

8. BANDAR *

(Town)

9. NO. TELEFON

(Telephone no.)

10. NO. TEL. BIMBIT

(Handphone no.)

11. PEKERJAAN

(Occupation)

12. PEMILIKAN SENJATA API *

(Firearms in possession)

Ada (Yes)

Tiada (No)

13. SENJATA API

Jenis senjata api (Gun)

Senapang (Shotgun)

Pistol (Pistol)

Rifel (Rifle)

Lain-lain (Other)

Other:

14. JENIS

Cth: Double Barrel (D/B), Over & Under (O/U), Side by Side (SxS), Semi-Auto, dll. (Type)

15. PEMBUAT

Cth: Beretta, Franchi, Glock, Remington, Walther, dll. (Make)

16. KALIBER

Cth: 12 Bore, 9mm, .22, dll. (Calibre/Caliber)

17. NO. LESEN SENJATA DAERAH

(District Arms Licence No.)

18. LESEN DIKELUARKAN OLEH

Cth: IPD K Sel, IPD Klang, dll. (License issued by)

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