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 dicatitkan 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 RM150      
   EXCO ⁄ EXCO ⁄ 领队 RM300
  (Fi Pembaharuan / Renewal Fee / 更新费 RM60)      
  (Fi Pembaharuan / Renewal Fee / 更新费 RM100)
ii) Baju Korporat/Corporate Shirt/会衣
  [size: S ] RM75     
  [size: M ] RM75     
  [size: L ] RM75     
  [size: XL ] RM75     
  [size: 2XL ] RM85     
  [size: 3XL ] RM85     
  [size: 4XL] RM100     
  [size: 5XL] RM100
iii) Baju Polo T ⁄ Polo T-Shirt ⁄ 衬衫
  [size: S] RM43      
  [size: M] RM43      
  [size: L ] RM43      
  [size: XL] RM43      
  [size: 2XL] RM50      
  [size: 3XL] RM50      
  [size: 4XL] RM60      
  [size: 5XL] RM60
iv) Baju Kolar Bulat ⁄ Roundneck T-Shirt ⁄ 圆领衬衫
  [size: S ] RM30      
  [size: M ] RM30      
  [size: L ] RM30      
  [size: XL ] RM30      
  [size: 2XL ] RM38      
  [size: 3XL] RM38      
  [size: 4XL] RM48      
  [size: 5XL] RM48
v) Baju Vest ⁄ Vest ⁄ 反光外套 **T&C 须符条件
  [size: S ] RM90      
  [size: M ] RM90      
  [size: L ] RM90      
  [size: XL ] RM90      
  [size: 2XL ] RM110      
  [size: 3XL] RM110      
  [size: 4XL] RM130      
  [size: 5XL] RM130
viii) Topi ⁄ Cap ⁄ 帽子
  RM22
xi) Sijil ⁄ Certificate ⁄ 证书
  RM10
x) Pelekat CP ⁄ CP Sticker ⁄ 车尾CP贴纸
  RM5
ix) Pelekat Cermin Depan / Windscreen Sticker / 车大镜贴纸
  RM10
vi) Pelekat Cukai Jalan / Road Tax Sticker / 路税贴纸
  RM30
vii) Insurans Kemalangan Diri ⁄ P.A.Insurance ⁄ 个人意外保险
  RM30
**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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