COMMUNITY POLICING MALAYSIA
Program Kepolisan Komuniti Malaysia

LANGUAGES : BM | ENGLISH



COMMUNITY POLICING MALAYSIA
(Program Kepolisan Komuniti Malaysia)
Sila lengkapkan semua bahagian borang dengan menggunakan HURUF BESAR dan tandakan (√ ) di kotak yang sesuai. Please complete all sections of the form in BLOCK LETTERS and tick (√ ) in the appropriate boxes. 请用大字母填写表格,在相关格子内打(√ ) 符号。

Saya ingin memohon menjadi Ahli Sukarelawan Program Kepolisan Komuniti Malaysia dan butir-butir peribadi saya adalah seperti di bawah. I would like to be a volunteer of Community Policing Malaysia and my particulars are as follows. 本人欲申请成为马来西亚人民社警计划志愿者,以下是本人之个人资料。

Nama Penuh mengikut Kad Pengenalan ⁄ Full Name as in NRIC ⁄ 姓名**
No. Kad Pengenalan Baru ⁄ New IC No. ⁄ 身份证号码**
Negeri Lahir ⁄ Birth State ⁄ 出生州属**
Tarikh Lahir ⁄ Birth Date ⁄ 出生日期**
Umur ⁄ Age ⁄ 年龄**
Jantina ⁄ Gender ⁄ 性别**
  Female         Male
Pekerjaan ⁄ Occupation ⁄ 职业**
Alamat Semasa ⁄ Current Address ⁄ 现时住址**
No. Telefon Rumah ⁄ Home Phone No. ⁄ 住家电话号码
No. Telefon Bimbit ⁄ Handphone No. ⁄ 手机号码**
**Type [ON >space< CP] send SMS to 33555 for receive crime/CP info
Alamat E-mel ⁄ E-mail Address ⁄ 电子邮址
Balai Polis Berhampiran ⁄ Nearest Police Station ⁄ 邻近警察局
Daerah Polis ⁄ Police District ⁄ 所属警区
i) Kad ID⁄ ID Card ⁄识别证 :
  Ahli Biasa ⁄ Ordinary Member ⁄ 普通队员 RM50      
   EXCO ⁄ EXCO ⁄ 领队 RM130
ii) Lencana ⁄ Badge ⁄ 衣领徽章:
  Ahli Biasa ⁄ Ordinary Member ⁄ 普通队员 RM10      
   EXCO ⁄ EXCO ⁄ 领队 RM15
iii) Baju Korporat/Corporate Shirt/会衣
  [size: S ] RM70     
  [size: M ] RM70     
  [size: L ] RM70     
  [size: XL ] RM70     
  [size: 2XL ] RM80     
  [size: 3XL ] RM80     
  [size: 4XL] RM80
iv) Baju Polo T ⁄ Polo T-Shirt ⁄ 衬衫
  [size: S] RM40      
  [size: M] RM40      
  [size: L ] RM40      
  [size: XL] RM40      
  [size: 2XL] RM45      
  [size: 3XL] RM45      
  [size: 4XL RM45
v) Baju Kolar Bulat ⁄ Roundneck T-Shirt ⁄ 圆领衬衫
  [size: S ] RM28      
  [size: M ] RM28      
  [size: L ] RM28      
  [size: XL ] RM28      
  [size: 2XL ] RM35      
  [size: 3XL] RM35      
  [size: 4XL] RM35
vi) Peti Lawatan CP ⁄ CP Visitation Box ⁄ 巡逻信箱
  RM65
ix) Pelekat Cermin ⁄ Windscreen Sticker ⁄ 车镜贴纸
  RM10
vii) Insurans Kemalangan Diri ⁄ P.A.Insurance ⁄ 个人意外保险
  RM30
x) Pelekat CP ⁄ CP Sticker ⁄ 车尾CP贴纸
  RM5
viii) Topi ⁄ Cap ⁄ 帽子
  RM20
xi) Sijil ⁄ Certificate ⁄ 证书
  RM10
**Uploading photo & IC photocopy [ Front & Back ] with Jpeg only**
upload passport size photo
upload IC photocopy [Front]
upload IC photocopy [back]
  I hereby confirm that I have read and accept the terms and conditions stated in the form.
**Tandatangan Pemohon ⁄ Applicant’s Signatory ⁄ 申请人签名 :
Tarikh ⁄ Date ⁄ 日期
Disokong Oleh ⁄ Seconded By ⁄ 介绍人 :
No. Tel ⁄ Handphone No. ⁄ 手机号码 :
**Maklumat WAJIB / Compulsory Details/ 强制性资料
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