etr mohamad shukry_b._maksah_05

ETR 300ENTREPRENEURSHIP

"BUSINESS PLAN"

FRESH CHICKEN FARM

NAME OF PARTNERS:

1. MOHAMAD SHUKRY B. MAKSAH 20032305402. MUHAMMAD FAIRUZ B. JOHARI 20032317143. MUHD. NURFAIZ B. BAHARUDDIN 20032316344. AHMAD LUQMAN B.

MOHAMED SHAIHANI 2003230883

Prepared For:

EN MALIKI B IBRAHIM (FKE)„ EN HUSNY B BASIR (MEDEC)

DIPLOMA IN ELECTRICAL AND ELECTRONIC ENGINEERINGFACULTY OF ELECTRICAL ENGINEERING

DATE OF SUBMISSION13 OCTOBER 2005

i

TABLE OF CONTENTS PAGE

COVER LETTER

ACKNOWLEDGEMENTS

AGREEMENT OF BUSINESS

ORGANIZATION LOGO

1 - m

iv

v-vii

1

INTRODUCTION

1.1 EXECUTIVE SUMMARY

1.2 BUSINESS PLAN PURPOSE

1.3 BACKGROUND OF OWNERS

1.4 PARTNER'S PROFILE

3

4

5

6-9

ADMINISTRATION PLAN 10

2.0 INTRODUCTION TO THE ORGANIZATION

i. VISION

ii. OBJECTIVE

iii. BUSINESS ADDRESS

iv. LOCATION PLAN

v. TYPES OF BUILDING AND INFRASTRUCTURE

a) OFFICE LAYOUT

2.1 ORGANIZATION CHART OF FRESH CHICKEN FARM

2.2 LIST OF ADMINISTRATION PERSONNELS

2.3 SCHEDULE OF TASK AND RESPONSIBLITIES

2.4 SCHEDULE OF REMUNERATION

2.5 LIST OF OFFICE EQUIPMENTS AND SUPPLIES

2.6 ADMINISTRATION BUDGET OF FRESH CHICKEN FARM

11

12

13

14

15

16

17

18-20

20

21

22

MARKETING PLAN 23

3.0 INTRODUCTION 24

3.1 PRODUCT OR SERVICE DESCRIPTION

3.2 TARGET MARKET 25

3.3 MARKET SIZE

3.4 MAIN COMPETITORS 26

/. STRENGTHS OF COMPETITORS 27

ii. WEAKNESSS OF COMPETITORS

iii. STRENGTHS OF FRESH CHICKEN FARM

3.5 MARKET SHARE 28

3.6 SALES FORECAST 29 - 30

3.7 MARKETING STRATEGIES 31

i. PPRODUCT

ii. PRICING

iii. PLACE/DISTRIBUTION 32

iv. PROMOTIONS 33

3.8 MARKETING BUDGET 34

OPERATION PLAN 35

4.0 INTRODUCTION 36

4.1 FLOW CHART OF OPERATION ACTIVITIES 37

i. FLOW CHART CONVENTIONAL SYMBOLS 38

ii. PROCESS FLOW CHART 39

4.2 OPERATIONS SYSTEM

i. READY OF BOILER CLOSED HOUSE 40

ii. INSTALL THE NECESSARY BROODING EQUIPMENT

a. DRINKER SYSTEM 41

b. FEEDING SYSTEM 42

c. PAD COOLING SYSTEM 43

iii. CHICK PLACEMENT 44

iv. CHICK QUALITY

v. DAILY CONTROL AND QUALITY CONTROL

a. VENTILATION 45

b. FEED AND WATER 46

c. LIGHT 47

d. DISEASE CONTROL

e. BIO-SECURITY

vi. GROWING PHASE 48

a. UNIFORMITY

b. MODIFICATION OF FEED AND NUTRIENT INTAKE

c. LIGHTING PROGRAMS 49

vii. CATCHING PROCESS

viii. DISINFECTION 50

4.3 BUSINESS OPERATION TIME

4.4 CAPACITY PLANNING 51

4.5 TOTAL COST 52

4.6 MATERIAL REQUIREMENTS (INPUT)

4.7 LIST OF OPERATIONS PERSONNEL 53

4.8 SCHEDULE OF TASKS AND RESPONSIBILITIES

4.9 SCHEDULE OF REMUNERATION 54

4.10 MACHINE AND EQUIPMENT 55-57

i. INFRASTRUCTURE DEVELOPMENT

ii. EQUIPMENT AND MACHINERY

4.11 OPERATIONS SPACE LAYOUT PLAN 58

4.12 OPERATION OVERHEAD 59

4.13 OPERATION BUDGET 60

FINANCIAL PLAN 61

5.0 INTRODUCTION 62

i. OBJECTIVE 63

5.1 PROJECT IMPLEMENTATION COST SCHEDULE 64

5.2 SOURCE OF FINANCE SCHEDULE 65

5.3 SUPPORTING SCHEDULES 66

i. LOAN OF AMORTIZATION SCHEDULE

ii. FIXED ASSET DEPRECIATION SCHEDULE 67 - 71

5.4 PROFORMA FINANCIAL STATEMENTS

i. CASH FLOW PROFORMA (ANUALLY) 72 - 73

ii. PROFORMA PROFIT AND LOSS ACCOUNT FRESH 74

CHICKEN FARM

iii. PROFORMA BALANCE SHEET ACCOUNT FRESH 75

CHICKEN FARM

CONCLUSION / RECOMMENDATIONS 76 - 77

APPENDIXES 78

Diploma In Electrical and Electronic Engineering,

Faculty of Electrical Engineering,

Mara University of Technology,

Shah Alam Campus,

40450 Shah Alam,

Selangor.

En. Husny B. Basir

Lecturer of Fundamentals of Entrepreneurship (ETR 300)

MEDEC,Blok 13

Intekma Resort & Convention Centre (Level 4)

40450 Shah Alam

Selangor Darul Ehsan

Dear Sir,

Submission Of Business Plan

Referring to the matter above, Fresh Chicken Farm would like to submit the business

plan for your analysis and references. Fresh Chicken Farm would start our business with

partner and address mentioned below:-

Details of partners are as follows:-

1. Mohamad Shukry B. Maksah 2003230540

2. Muhammad Fairuz B. Johari 2003231714

3. Muhd. Nurfaiz B. Baharuddin 2003231634

4. Ahmad Luqman B. Mohamed Shaihani 2003230883

Business address:-

FRESH CHICKEN FARM

Lot 3307, Batu 7,

Lorong Sarkawi,

Jalan Kebun

42 450 Klang,


We have tried our best to prepare this business plan with all data compiles for your good

judgments. This working paper is a group effort and all experiences gained are valuable

lesson for entire group members.

We hope that our business plan will satisfy your requirement for this subject (ETR 300). We

also hope that our business plan can give some benefit to other people especially as a

reference material for the future.

Yours sincerely,

(Mohamad Shukry B. Maksah)

General Manager

(Muhd. Nurfaiz B. Baharuddin)

Marketing Manager

lammad Fairuz B. Johari)

Operation Manager

(Ahmad Luqman B. Mohamed Shaihani)

Financial Manager

in

ACKNOWLEDGEMENT

We would like to thank ALLAH S.W.T for His blessings that we were able to

finish this assignment. We would also like to thank our lecturers, En Maliki and En

Husny for the guidance and lectures that have given us a clear view on how to document

our business plan.

In preparing the plan, we have also come across several individuals and

interviewed them for information gathering. We would like to extend our gratitude to

them particularly En Baharen and En Azaruddin because of their willingness to spend

their time in answering our questions regarding chicken business.

Last but not least, we would also like to thank our classmates who have helped us

in answering questions related to the business plan. Their generosity and assistance are

greatly appreciated.

IV

AGREEMENT OF BUSINESS

The agreement letter has been made on 28 July 2005 between 4 partners of the

company and below is the list of partners and the agreed terms.

Mohamad Shukry B. Maksah

850628-10-5221

41 Jin Sri Damak 50,

Taman Sri Andalas,

41200 Klang,

Selangor.

Muhd. Nurfaiz B. Baharuddin

850720-14-5883

167 Jin. Tun Abdul Razak,

Taman Sri Andalas,

41200 Klang,

Selangor.

Muhammad Fairuz Bin Johari

851107-07-5455

99 Jin. Sri Damak 22,

Taman Sri Andalas,

41200 Klang,

Selangor.

Ahmad Luqman B. Mohamed Shaihani

850515-10-5559

11 Jin. SriSedeli5,

Taman Sri Andalas,

41200 Klang

Selangor.

Partners of Fresh Chicken Farm have agreed to all the terms and conditions that have

been discussed and all the terms and conditions of the company are stated as below:

1. The partners have agreed with the name of the company Fresh Chicken Farm

and all businesses with the company should apply the mailing address as

below:

FRESH CHICKEN FARM

Lot 3307, Batu 7,

Lorong Sarkawi,

Jalan Kebun

42450 Klang,


2. All partners agree with the reasonable salaries given to them.

3. Documents such as profit and loss statement, balance sheet and other confidential

documents shall not be revealed to others.

4. Every partner is entitled to participate in the management of the business.

5. Every partner knows of the risk and agrees that the liability for the company is

unlimited and we are ready to pay off all liabilities for the company with own

properties.

VI

Below are the signatures of all partners that have agreed with all the terms given above.

MOHAMAD SHUKRY B. MAKSAH

I/C: 850628-10-5221

MUHAMMAD FAIRUZ B. FOHARI

I/C: 851107-07-5455

MUHD. NURFAIZ B. BAHARUDDIN

I/C: 850720-14-5883

AHMAD LUQMAN B. MOHAMED SHAIHANI

I/C: 850515-10-5559

Vll

FRESH CHICKENFARM

DEFINITION OF THE LOGO

FRESH CHICKEN FARM | z ) Represent the name of our company.

CIRCLE SHAPE l~~> Represents unity between partners and all theemployees.

WHITE BIRDS

BLUE Hy

Represent our products

Represent the courage and hard work among thepartners and employees.

1.1 EXECUTIVES SUMMARY

This business is based on partnership where it consists of four (4) members.

The members consist of the General Manager, Administration Manager, Marketing

Manager, Operational Manager and Financial Manager. The business capital is

amounted to RM372,410 where the total contribution of each member is RM79,910

and the rest is from the Bank Pertanian loan.

FRESH CHICKEN FARM is a company related to the breeding the chicken

meat. Our market focus is for the Pertanian Pertiwi, a company that directly deals

with us, they will supply the day-old-chicks with the certain price and buy the chicken

back when it reach at certain age (normally at 50 days). For those who are interested

to buy the fresh chickens, we can't sell to them due to our contract with the Pertanian

Pertiwi.

Our business will be expected to commence on 2006 and our vision is to make

our company a well-known, established and satisfied by our customer in order to

expand our capacity of chickens and to attract other companies to deal with us with a

better price. This will be realized by the full cooperation and efforts among the

partners to promote this company.

Based on the objectives above, we are venturing into livestock industry.

Chickens' farming has the potential of being a profitable business if it's done in

modern way with large scale and systematically managed.

We will expect that our business will become more developed in the near

future because the demand for the chicken's meat is high and not many breeders use

the closed system. This will give more advantages for us to make our product more

profitable and stabile in the long run.

1.2 BUSINESS PLAN PURPOSE

The main purpose of this business plan is for the reference of several

audiences / parties such as:

1. The Entrepreneurs (Fresh Chicken Farm's managers).

To better understand the purpose of the business and act as guideline to

manage the business effectively and efficiently.

2. Financial Institutions.

Assist and help the financial institution to evaluate the capability of the

proposed project and provide loan for the business. Financial institution

involved in this business project is Bank Pertanian Malaysia.

3. Suppliers.

Help convince suppliers of the viability of our business venture thus benefiting

both the suppliers and our company in the long term business arrangement.

4. Company Staffs / Workers.

Help workers to understand the business's goals and objectives and give a

guideline to them regarding their job duties and responsibilities.

5. Customers.

Persuade and influence our customers regarding the products being offered

and gives assurance and confidence to them to have business with us.

13 BUSINESS BACKGROUND

Below is the business background for our company:-

Name of Business/Company : FRESH CHICKEN FARM

Address : Lot 3307, Batu 7,

Lorong Sarkawi,

Jalan Kebun,

42450 Klang,

Selangor Darul Ehsan.

Telephone : 03-31222372

Fax No. : 03-31222375

Form of Business

Main Activities

Date of Registration

Number of Registration

Date of Commencement

Initial Capital

Name of Bank

Account No.

: Partnership

: Providing services of breeding the chicken meat.

: In progress

: hi progress

: hi progress

: RM 79,910

: Bank Pertanian Malaysia

: 40950003456

1.4 PARTNER'S PROFILE

1. Name Mohamad Shukry B. Maksah

Identity Card Number

Permanent Address

Telephone No.

Date of Birth

Age

Marital Status

Academic Qualification

Courses Attended

Skills

Experience

Present Occupation

Previous Business

Experiences

: 850628-10-5221

: 41 Jin. Sri Damak 50, Taman Sri Andalas,

41200 Klang, Selangor.

: 019-3079070

:28 th June 1985

: 20 years old

: Single

: Diploma In Electrical Engineering

: Entrepreneurship

: Computer related

:None

: Undergraduate

:None

: None

2. Name Muhammad Fairuz B. Johari


Permanent Address

Telephone No.

Date of Birth

Age

Marital Status


Courses Attended

Skills

Experiences

Present Occupation

Previous Business

Experiences

: 851107-07-5455

: 99 Jin. Sri Damak 22, Taman Sri Andalas,


: 017-3082892

:7 t h November 1985

: 20 years old

: Single


: Entrepreneurship

:None

: None

: Undergraduate

: None

: None

3. Name Muhd. Nurfaiz B. Baharuddin


Permanent Address

Telephone No.

Date of Birth

Age

Marital Status


Courses Attended

Skills

Experiences

Present Occupation

Previous Business

Experiences

: 850720-14-5883

: 167, Jalan Tun Abdul Razak, Taman Sri

Andalas, 41200 Klang, Selangor.

: 012-6045320

: 20th July 1985

: 20 years old

: Single


: Entrepreneurship

: None.

: None.

: Undergraduate

: None

:None

4. Name


Permanent Address

Telephone No

Date of Birth

Age

Marital Status


Courses Attended

Skills

Experiences

Present Occupation

Previous Business

Experiences

: Ahmad Luqman B. Mohamed Shaihani

: 850515-10-5559

: 11 Jin. Sri Sedeli 5, Taman Sri Andalas,


: 012-9157455

: 15th May 1985

: 20 years old

: Single


: Entrepreneurship

: None

: None

: Undergraduate

: None

:None

Fl

yj J 7J

10

2.0 INTRODUCTION TO THE ORGANIZATION

Administration plan is first step of business to become more developed and

expounded in the future. It is important in every business. The effectiveness of

FRESH CHICKEN FARM is based on the administration that has been planned

systematically and followed by the proper planning before the business is established.

The important things that have been taken care of are well organization and

effectiveness in administration plan.

Several things that are included in this part are;

> Organization planning

> Organization chart

> Numbers of workers/labor

> Administration budget

> Office layout

> Remuneration Table

> Workers intensive

^ Position, responsibilities and specific task

Vision

It is FRESH CHICKEN FARM to be strength and famous farm over the world

as a quality and fresh "chicken" provider in order to fulfill an increase of market

demand for this favorite chicken by the year 2015. FRESH CHICKEN FARM should

be promoted to other countries to our vision that our local favorite chicken is to meet

a satisfying among foreigners.

11

Objective

1) Justly to compensate the employees and owners of FRESH CHICKEN

FARM.

2) Contribute to the development and growth of the country's economy and to

increase the percentage of Bumiputera involves in business

3) To create productivity among employees

4) To provide the best quality of "chicken" every time in order to attract more

customers

Business Address

Our business will be situated at the following address:

FRESH CHICKEN FARM

Lot 3307, Batu 7,

Lorong Sarkawi,

Jalan Kebun

42 450 Klang,


12

b) Location Plan

HOUSE AREA

LORONGAKTBAKSR"• FRESH •

• CHICKEN •

• FARM *

MARDI

JAUWKH

FROM KUA1A LUMPURKESAS HIGHWAY

-mrnmm

PROTONSERVICECENTER

FROM HAH ALAM

ECONSAVE

(AMPIINGJA^I

ESSO

TEMPLE

HOUSE AREA

Shell

PUUWMDAH

TESCO

BUWTTWGGJGIANT

KLANG

Hospital BesarKlang

13

Type of Building and Infrastructure

Among the facilities that are provided at our project site are:

1. Office

2. Toilet

We have chosen a project site which has all the necessary facilities and infrastructure

as a catalyst for the growth and development of our business, FRESH CHICKEN

FARM. Our business is situated only 45 minutes away from Kuala Lumpur through

KESAS highway.

Among the many infrastructures that can be found in the project site are:

a) An excellent highway system where it can facilitate the customers to frequent the

project site and buy our products. It will also make it more convenient for the

suppliers to come and supply the raw materials needed by our company.

b) Electricity power supply has already been provided by the Tenaga Nasional Berhad

along the Jalan Kebun.

c) Telephone line has already been made available by the Telekom Malaysia Berhad

and also water supply from the Water Department along Jalan Kebun.

14

OFFICE LAYOUT

D 1—*-* i—*—*—— i—

<

)

FINANCIALMANAGER

OPERATIONMANAGER

)GENERALMANAGER

t F ^DaMARKETINGMANAGER

KEYS:

Chair Sofa Telephone

BoardComputer Toilet White

Table

15

2.1 ORGANIZATION CHART OF FRESH CHICKEN FARM

ADMINISTRATIONMANAGER

GENERAL MANAGER

MARKETINGMANAGER

OPERATIONMANAGER

WORKERS

FINANCIALMANAGER

WORKERS

The style of the organization chart is designed on functional style. The

organization structure on functional style is very effective to the any company which

are need peculiar specialize.

16

2.2 LIST OF ADMINISTRATION PERSONNELS

SERIES

1

2

3

4

5

6

POSITION

General Manager

Operation Manager

Administration Manager

Marketing Manager

Financial Manager

Trained Workers

TOTAL

NO OF PERSONAL

1

1

1

1

1

2

7

17

2.3 SCHEDULE OF TASK AND RESPONSIBLITIES

POSITION

General Manager

Administration Manager

TASKS AND RESPONSIBILITIES

• Making connection and establishing contact

with the main supplier, PERTANIAN

PERTIWI SDN BHD.

• Form the business policies and guidelines

• Making decisions and solve all problems

faced by Fresh Chicken Farm.

• Help the Marketing Manager to promote the

chicken products.

• Find out more information and do research

about setting up and operating a chicken's

farm successfully.

• Choose quality livestock from the supplier,

PERTANIAN PERTIWI SDN BHD.

• Responsible and liable for all business risks or

any problems regarding business or workers

• To forecast sales and income

• To administrate the business structure

• Lay out all plans and ensure that all things are

done according to plans

• Determine the wages and salaries received by

workers and contribute the percentage of the

salaries to EPF and SOCSO.

• Make the decisions regarding administrative

tasks and office works.

• Responsible for all mails and correspondences

connected with the business.

• To assist general manager in the business

• To involve in guiding a new worker in case of

a new recruitment

• Help to achieve the business target by

implementing business ideas and strategies

18

Marketing Manager

Operations Manager

Financial Manager

• Find other strategies to help increase sales

• Analyze the strengths and weaknesses of

competitors.

• Handle the advertisement, banners and

signboard placement.

• Make sure the customer receive good service.

• Able to interact and try to make the customers

to have confidence in our business

• To analyze the opportunity in the economy,

choose and grab the opportunity based on the

business

• Find and place a suitable pricing for every

chicken product sold.

• Deal in the buying of food for the chicken

• Responsible for the training of new workers

and monitor the job quality of all operation

workers.

• Monitor th§ health of chickens.

• To make sure that all stocks are in good

condition

• To make sure all the stocks are enough to

meet the demand

• Informing suppliers when there are extra

orders needed

• Prepare the company financial report

• Keep all the financial records and business

accounts in the safety place.

• Record and monitor all the income received

and expenses incurred by the business.

• Responsible for controlling and managing

company's financial capital and cash flow.

19

• Advice the manager regarding the

matters.

• Make a budget of business example

financial

financial

statement, profit, and loss account, and

balance sheet

• Search for the information of capital

activities.

and asset


DESIGNATION

General Manager

Operation Manager

Admin Manager

Marketing Manager

Financial Manager

Trained Workers

TOTAL

NO OF

EMPLOYEE

1

1

1

1

1

2

7

MONTHLY

SALARY

(RM)

1,700.00

1,300.00

1,300.00

1,300.00

1,300.00

1,000.00

7,900.00

EPF

(12%)

(RM)

204.00

156.00

156.00

156.00

156.00

120.00

948.00

socso(2.5%)

(RM)

43.00

33.00

33.00

33.00

33.00

25.00

200.00

TOTAL

(RM)

1,947.00

1,489.00

1,489.00

1,489.00

1,489.00

1145.00

9,048.00

20

2.5 LIST OF OFFICE EQUIPMENTS AND SUPPLIES

NO

1.

2.

TYPE

OFFICE EQUIPMENTS

a. COMPUTER (PARTNERS

CONTRIBUTION)

b. AIR CONDITIONER

c. TELEPHONE & FAX

MACHINE

d. FIRST AID

e. WHITE BOARD

f. CABINET/FILE FOLDERS

g. ADDITIONAL

ACCESSORIES

TOTAL

FURNITURES

a. CHAIRS

b. SOFA

c. TABLE

TOTAL

QUANTITY

1

1

1

1

1

4

8

1 SET

4

PRICE/UNIT

(RM)

1,180

1,000

100

120

400

60

1,100

150

TOTAL

(RM)

2,500

1,180

1,000

100

120

1,600

170

6,670

480

1,100

600

2,180

21

2.7 ADMINISTRATION BUDGET OF FRESH CHICKEN FARM

TYPE

Fixed Asset:

Land &Building

Furniture

Office equipments

Renovation

Monthly Expenses:

Salary, EPF, SOCSO

Stationary

Miscellaneous

Telephone bill

Other Expenses:

Registration & Licenses

Deposit

Insurance & Road Tax

Other Expenses

Fixed Asset

Cost

(RM)

138,000

2,180

6,670

-

-

-

-

-

-

-

Monthly Expenses

(RM)

-

-

-

-

6,414

50

100

500

100

-

-

Yearly Expenses

(RM)

-

-

-

-

76,968

600

1,200

6,000

1,200

-

-

22

3.0 INTRODUCTION

Marketing is a social and managerial process by which individuals and group

obtain what they need and wants through creating and exchanging products and value

with others. It can be defined as an activity that are carried out systematically to

encourage and increase sales of products or services as long as the activities are in the

line with religious and ethical practices.

Marketing is basically an exchange activity that takes place between a

business entity and its customers. The customers can conclude individuals, others

business entities (e.g. wholesalers and retailers) and support organizations (e.g. banks

and government agencies). Marketing is a critical activity in any business because it

forms the backbone to the total business effort in achieving a profitable outcome.

Consequently, the challenge in any business is to produce and offer a product that

results in profit for the business and, more importantly, satisfies the target customer.

r

3.1 PRODUCT OR SERVICE DESCRIPTION

Our business will be name as 'FRESH CHICKEN FARM'... holding one

marketing concept where our operation, strategy and manufacturing are done

regarding customer's needs and wants. In the other words, the customer satisfy is a

major concerning in every effort and strategy to ensure that our business can be

compete and more longer in market.

We have chosen a business that deal with the distributor, whereby they are an

agreement that the distributor will supplies the chick to us, then we will breed its until

a certain level before the chicken return back to them. There are only 18,000 chicks

per batch that we will take. It takes a year the contract of this business.

24

3.2 TARGET MARKET

The target market is defined as the groups of customers that have needs and

wants that can be satisfied by the business through the supply of goods and services.

It's important for us to have a target market to determine our customers needs and

wants towards chicken.

Since that our business has a contract with other company, which is our

distributor, therefore, our target market is 'Pertanian Pertiwi Sdn Bhd'(distributor).

Our company does not have a specific area or outlet to distribute our product because

we have a deal with the distributor. In the agreement, it states that we will get the

supplies (chicks) from the distributor and after a certain level, we will sell it back to

the distributor.

3.3 MARKET SIZE

Market size refers to the total potential purchase of the target market. Since we

have a contract, so the market size is depend on the purchasing of our distributor.

According to our distributor, we had been informed that their annual sale is

RM15,779,840. Therefore this is our market size. The table below shows the target

market of their company.

OUTLET

Wet Market

Hotel

Restaurant

Factory / School Canteen

Individuals

TOTAL

EXPECTED PURCHASE

Per year (RM)

5,52,944

3,155,968

4,733,952

1,577,984

788,992

15,779,840

PERCENTAGE

(%)

35

20

30

10

5

100

25

3.4 MAIN COMPETITORS

In our business operating, there are many competitors that operate a same

business like us. Competitors actually refer to other businesses that offer similar,

substitute or an alternative products or services to the same target market. We have to

analyze the strengths and weaknesses of our competitors in term of size, experience,

and years in business, financial ability and product line in order to compete together

with them.

Here we have identify some entrepreneurial that operate chicken business

located in the same area:

Hj. Kamaruddin b Hj. Ellyas

Kim Too Siong

En Baharen M.Daie.

All the above competitors have been long in this business before we entered

the business. Therefore, most probably they have established themselves and have

more experience in facing towards customers. What can we do is trying to have a

good business and make the competitors as our activator to succeed in the business.

26

STRENGTHS OF COMPETITORS

> They have been in the business for a long time before us and make them

already have permanent customer.

> They have a large source of capital to expand their market.

> They have more experience in operating the business compared to us.

Customers know them well and more confident to work with them.

WEAKNESSS OF COMPETITORS

^ Their operation management is not systematically.

^ The price of the chicken is not suitable with the quality of the product selling.

> Their farm is 'open system', produce low quality product.

> Less promotion to spread widely their business.

STRENGTHS OF FRESH CHICKEN FARM

^ Our operating is more systematic to ensure that our chickens are grower in

better condition.

> Our price is suitable with the size of chicken selling.

> We care of the quality of the chicken selling to buyer.

> Applied high technology on the farm. (Close system)

> We have well in promotion and ensure a good relationship with our

distributor.

* Nevertheless, we have our weakness that we are still new in our business and have

less experience compared to other competitor.

27

3.5 MARKET SHARE

Market share refers to the estimated potential sales of the business after taking

into consideration of the market size and competitors influences. Based on our market

size, RM 15,779,840 we can estimate our 5% share of market.

The table below shows the market share before and after 'FRESH CHICKEN

FARM' entered market.

Name of

Company

Hj. Kamrauddin b.

Hj. Ellyas

Kim Too Siong

En Baharen M.Daie

Others

'FRESH CHICKEN

FARM'

TOTAL

Before

%

share

25

20

15

40

100

Amount

(RM)

3,944,960

3,155,968

2,366,976

6,311,936

15,779,840

After

%

share

25

20

15

35

5

100

Amount

(RM)

3,944,960

3,155,968

2,366,976

5,522,944

788,992

15,779,840

28

3.6 SALES FORECAST

Sales forecast is expected purchases from the identified target market. There

will be an increase in our sales every year for our three years forecast seems that the

high demand for chicken in the market. There is a possibility that the customers needs

a better quality of chicken and choose us as their new supplier.

The following table shows the forecasted sell for the first three years.

Sales Forecast for year 2006,2007 and 2008 (RM)

MONTH

January - February

March - April

May - June

July - August

September - October

November - December

Total-2006

Total-2007

Total - 2008

NO OF

UNIT (kg)

41,055

41,055

41,055

41,055

41,170

41,170

246,500

246,500

246,500

SELLING PRIZE

(RM/kg)

3.20

3.20

3.20

3.20

3.20

3.20

3.20

3.20

3.30

AMOUNT

(RM)

131,376

131,376

131,376

131,376

131,744

131,744

788,992

788,992

813,450

In our business, we have a certain period of time to produce our product.

Operation of our product will take about two month before it's will be market.

Therefore, we just can make a forecast per batch, which means every two-month we

will gain in sales.

We start our project in January and get 18,000 of chick from the distributor.

From the table above, our product that we sell to the distributor is 41,055, which is

17,850 of chicken with average weight 2.3kg in the first, second, and third batch (Jan-

Aug). We expect that 150 chicken will died. On the forth and fifth batch, there are

only 100 died. To achieve this target, we will make sure that our operation was good.

The distributor also will help us by giving an extra 200 of chicks in every batch. On

29

September to December, they will give us extra 250 of chicks because of the festival

season.

From the graph below, it shows that our selling forecast in year 2006, 2007

and 2008. In the agreement, the price for a chicken is fixed, RM3.20/kg. The graph

shows that the pattern of selling in year 2006 and 2007 is same and in 2008, it will

increase 3% by increasing our selling price to RM3.3O/kg while we renew our

agreement with the distributor.

Graph On Sales Forecast

136,000

135,000

134,000

Amount 1 3 3 0 0 0

(kg) 132,000

131,000

130,000

129,000

— _ _

n rr r1

1 .,

i1

1 1 1

Month

n

-j

D Year 2006• Year 2007

„ • Year 2008

30

3.7 MARKETING STRATEGIES

Our business operating is supplying the meat chicken. In this business, we are

dealing with other company as a distributor which they as an agent to distributed our

product. We supply the chicken and they processed the chicken for selling to the

customer. Therefore, our marketing strategy is to make the distributor more confident

towards our quality of product. In order to achieve our target, we have developed

appropriate marketing strategies to generate the sales from the target market. There

are four factors to be considered which are as follows;

a) Product

b) Price

c) Place (distribution)

d) Promotion

a) Product

Our farm provides a good quality of chickens, which are from a good

heredity (grade A) and free from infectious disease. We will operate our farm

carefully to ensure that it's always been satisfy by our distributor. In this business, the

distributor will give a guideline for us to control our quality of products. To achieve

the standard level of our product, we will make sure that our operation will operate

according to the guideline given. Besides, the distributor will come to our farm every

two weeks to make sure that our chickens have a good health.

Our business provides a clean environment of a farm, which is very important

for giving a view to our quality product. A good quality of chicken also comes from

their good quality of feed.

b) Pricing

The price of chicken is fixed based on our agreement with the

distributor. Otherwise, in order to put a price for our product, we are using

'competition-based pricing' concept and make a comparison regarding quality and

31

size of the chicken. The proper price fixed by our business is RM3.20/kg where

usually the price fixed by competitors is RM3.50/kg.

c) Place/Distribution

We have chosen Jalan Kebun at Klang as our project site based on some

factor;

• Farm is far away from town and housing area

• Farm have access to transportation and be able to operate all the time

• Land are flat and have good drainage

• The area is well ventilated

Seems that our location is in Klang , its will encourage the distributor to make a deal

with us.

d) Promotion

An impressive promotion is needed to ensure that our missions are achieved.

A step of promotion should be taken in order to achieve our vision to make everyone

known our potential and get a chicken supply from our company.

Promotions are based on;

• Signboard

It's very important for each business to have a signboard to introduce the business

and let everyone know the location of the project site. Our business will have two

signboards that will be put in front of our office and the side of road that mention

the way to our farm.

• Business card

Our business card will be given especially to our vendors who visit our farm.

It's make people know how to contact us as a manager to make a business or

directly come to our farm based on address given.

32

Website

We will make a business website for our company seems that Internet is the

most important communication tool among the communities nowadays. All

information regarding our business will be advertised in the homepage

FreshGbkkenFarm

MOHAMMAD SHUKEYB. MAKSAH

(General Manager)

Lot 3307, Batu 7, LorongS&rkawi, Jalart Kebun,42450 Klang,Tel:03-31222372H/p : 019-3079070www. f reshchickenfa rm. com

FreshChicken F&rtn

MUHD NURFAIZB. BAHARUDDIN

(Marketing Manager)

Lot 3307, Batu 7, LorongSarkawi, Jalan Kebun,42450 Klang,Tel:03-31222372H/p : 012-6045320www. f reshchickenf a rm.com

Fresh€hickn Farm

MUHAMMAD FAIRUZ

B JOHARI

(Operation Manager)

Lot 3307, Batu 7, LorongSarkawi, Jalan Elebun,42450 Klang,Tel: 03-31222372H/p : 017-3082892www. f reshchickenf a rm. com

33

Fresh

AHMAD LUQMAN B.MOHAMMED SHAIHANI

(Financial Manager)

Lot 3307, Batu 7, LoiongSarkawi, Jalan Kebun,42450 Klang,Tel : 03-31222372H/p : 012-9157455www. f reshchickenfa rm. com

3.8 MARKETING BUDGET

Remuneration Table Monthly

POSITION

Marketing

Manager

MONTHLY

SALARY (RM)

1300

EPF

12%

(RM)

156

socso2.5%

(RM)

33

TOTAL

(RM)

1489

List Of Marketing Budget

Type

Fixed Asset

Signboard

Working Capital

Salary, EPF, SOCSO

Miscellaneous

Other Expenses

Business Card

Fixed Asset Cost

(RM)

500

Monthly Expenses

(RM)

200

Other Expenses

(RM)

100

34

4.0 INTRODUCTION

Operation Management

Operation management can be defined as the process of marshalling resources

to produce output through the transformation process. The operation process

comprises three main components, i.e. business input, transformation system and

output.

Business input refers to all resources required to produce a particular output.

Examples of input are manpower, raw materials, machines and equipment,

technology, information and capital. The transformation system refers to the activities

involved in transforming input into output. Among others, the processing system

involves planning of raw materials, designing of operational process, planning of

floor layout and distributing of manpower in the organization. Output refers to the end

product created as the result of the transformation process. Business output can be

categorized into either products or services. As input is transformed into output, it

acquires added value, whereby the value of the output is higher than the total input

value.

Our purpose focus in operational plan is to breed and to ensure chicken that

we supply is high quality to fulfill our customer needs and wants. With the quality,

exact time and place we planned at the lowest cost but give an optimum profit, which

will avoid misspend money.

It also to recognize and list down all the materials needed to effort by making

some arrangement for the quantity and quality of material needed and recognized

supplier.

36

4.1 FLOW CHART OF OPERATION ACTIVITIES

It is schematic representation of the operation process from the start until the end.

Ready of broiler closed house

Install the necessary brooding equipment

Received a day-old-chick (DOC)

Keep DOC in broiler close house

Check the chick quality

Daily control and quality control

Waiting for a growing process

Catching process

Distributor takes back the chicken

Disinfection process

37

FLOW CHART CONVENTIONAL SYMBOLS

SYMBOL

o

V

ACTIVITY

OPERATION

TRANSPORTATION

INSPECTION

DELAY

STORAGE

DESCRIPTION

Material are being

processed of planning and

calculating

Received and return the

chicken to the supplier and

delivered it to the customer

Inspection on the size,

weight, quality of the

chicken we ordered and

delivered

Waiting a growing process

Material and property are

stored in the storage

38

PROCESS FLOW CHART

1) Ready of broiler closed house

2) Install the necessary brooding equipment

3) Received a day-old-chick (DOC)

4) Keep DOC in broiler close house

5) Check the chick quality

6) Daily control and quality control

7) Waiting for a growing process

8) Catching process

9) Distributor takes back the chicken

10) Disinfection process

39

4.2 OPERATIONS SYSTEM

1) Ready of broiler closed house.

Our breeding project of day-old-chick required our company to build pens on

2.273 acres. Before we have building and planning construction of a boiler house,

firstly we select a site that is on well-drained land and has plenty of natural air

movement. The house should be oriented on an east-west axis to reduce the amount of

direct sunlight on the sidewalls during the hottest part of the day. The house is single-

storey and has a wide of 350 feet x 40 feet x 7 feet. The design is such that chickens

are not exposed to injury. This is close house system, so there is an alarm signal.

These alarm signals are useful to give a warning during a blackout. Then the

generator will be used to provide a power electric.

40

2) Install the necessary brooding equipment

a) Drinker System

This system providing clean, cool water with adequate flow rate is

fundamental to good poultry production. Without adequate water intake, feed

consumption will decline and bird performance will be compromised. Our company

has used closed systems {nipple systems).The nipple drinkers operate at a flow rate of

50 to 60 ml/min. The pressure is adjusted to maintain water flow to meet the broiler's

water needs and to adjust it, we use regulator. Nipple drinkers will be adjusted to suit

chick height and water pressure. It must have evenly distributed pressure optimized

for output without contributing to excessive dripping.

41

b) Feeding System

Our company has used auto pan feeding system. This system is allowing for

unrestricted bird movement throughtout the house, has a lower incidence of feed

spillage, and improved feed conversion. In addition, pan feeders fill simultaneously

minimizing bird competition when the feed lines are charged. Automated chain

feeders allow for a minimum of 2.5 cm (lin) feeder space per bird. The maintenance

of feed track, corners, and chain tension is essential. If the height is not adjusted

properly, it can restrict bird movement within the house. The feed depth is controlled

by feed slides in the hoppers and will be closely monitored to prevent feed wastage.

L-

42

c) Pad Cooling System

We have to monitor level of ammonia, carbon monoxide, carbon dioxide,

hydrogen sulfide and oxygen. In closed house system from time to time to ensure it

does not affect health of chickens and workers. When the thermostats or probes

detects the temperature below 30°C the water will be automatically flow out from the

front of the pens. The machine is calling the pad cooling system. Then the exhaust fan

will pull out any gases and air that are not at the good level. The suitable temperature

is according to stage of growth.

43

3) Chick Placement

We buy a chick from our head company, Pertanian Pertiwi. This day-old-chick

will be sending to us more than 18000 of chicks. These chicks are from same flock or

same age. The delay in placement can contribute to the dehydration of chicks,

resulting in higher chick mortality and reduced growth rate. Chick must be carefully

placed and evenly distributed near feed and water throughout the brooding area. The

light will be brought to full intensity within the brooding area once all chicks have

been placed. We have to monitor the distribution of the chicks closely during the first

few days. This can be used as an indicator for any problems in feeder, drinker,

ventilation or heating systems.

4) Chick Quality

Two hours after chick placement, we will be checking their quality. This is to

ensure they are comfortable with the temperature. Chicks too warm will try to move

away from heat, will be panting, will appear quiet and their wings may drop. Chicks

too cold will crowds towards the heat, will huddle in groups and be noisy. While,

chicks at the correct temperature will be evenly spread, show varied behavior (eating,

drinking, resting and interacting) and will be softly chirping. Characteristics of a good

quality chick are well dried, long fluffed down, bright round active eyes, look active

and alert, have completely healed navels, free of red hocks and should be free from

deformities.

44

5) Daily Control and Quality Control

a) Ventilation

In order to the proper temperature, ventilation needs to be considered.

Ventilation distributes heat throughout the house and maintains good air quality in the

brooding area. We have to monitor level of ammonia, carbon monoxide, carbon

dioxide, hydrogen sulfide and oxygen. In closed house system from time to time to

ensure it does not affect health of chickens and workers. When the temperature

transducer detects the temperature below 30°C the water will be automatically flow

out from the front of the house. The machine is calling the cooling pad system. Then

the exhaust fan will pull out any gases and air that are not at the good level. The

suitable temperature is according to stage of growth

Description

Temperature

Air speed

Thermostat

Weekl

33°C

<50 ft/min

34°C

Week 2

32°C

100 ft/min

32°C

Week3

29°C

200 ft/min

30°C

Week4

29°C

300 ft/min

30°C

Week5

29°C

400-500 ft/min

30°C

Exhaust Fan

45

b) Feed and Water

Our broiler management is always making sure that both the feeders and

drinkers are in adequate supply relative to the stocking density and are approximately

placed. The nipple drinkers would be at chicks' eye level for the first 2 to 3 days of

age and then maintained slightly above chicks' head. Pressure would be such that

there is a droplet of water suspended from the nipple but no leakage. The birds' feet

are always being flat on the litter and a bird will never have to stand on its toes to

drink. Feed are provides in crumb form and placed on trays. Feeders will be raised

incrementally throughout the growing period so that the pan is level with the bird's

hack at all times. The feed level within the feeders will be set so that feed is readily

ivailable while spillage is minimized.

46

c) Light

Light intensity will be minimum of 20 lux (2 foot candles) in the darkness

place in the brooding area during the brooding phase. Light intensity, distribution,

color and duration affect the performance and welfare of the flock. Proper light

placement and distribution will encourage chicks to find feed, water and warmth

during the brooding phase.

d) Disease Control

The veterinary will come every week to monitor disease status in house on a

schedule basis. The culled chicken will be separate before its spread. The antibiotic or

vaccine will be put in water. The use of the correct medication and the timing of

treatment can be crucial in combating a disease problem. The preferred choice of a

drug or antibiotic for some disease may be harmful if used for the treatment of others.

e) Bio-security

Bio-security is the term used to describe an overall strategy or succession of

measures employed to exclude infectious diseases from a production site. Outlined

below are the key points that make us successful in bio-security program.

> Keep door and gate lock at all times.

> Farms are fenced.

> No pet animal that are allowed in or around poultry housing.

> Limit non-essential visitors to the farm.

> If equipment must come from another farm, it would be thoroughly

cleaned and disinfected before it comes onto the farm.

> Farms have a toilet and hand washing facilities separate from the

poultry house.

47

6) Growing Phase

a) Uniformity

Uniformity is measure of the variability of bird size in a flock. The coefficient

of variation (CV) is commonly used to describe variability within a population. A low

CV indicates a uniform flock whereas a high CV indicates an uneven flock.

Coefficient of Variation

CV% = standard deviation

To estimate the CV of a flock, we will divide the house into three sections. A

random sample of approximately 100 birds from each section, or 1% of the total

population will be weighed and the individual weights recorded. It is important to

weigh all birds within the catch pen excluding culls. Birds will be weighed daily for

the first two weeks of age and weekly thereafter.

Flock Uniformity

CV

8

10

12

Uniformity

80%

70%

60%

Evaluation

Uniform

Average

Poor uniformity

b) Modification of Feed and Nutrient Intake

Adjusting dietary nutrient density or the physical form of the feed (mash vs.

pellet) will influence broiler growth rates. Lower nutrient density diets may have a

negative impact on feed conversion and yield but will cost less to produce. An

analysis of dietary cost versus bird performance is essential in determining the best

option.

48

c) Lighting Programs

Lighting programs are a key factor in proper broiler management and are

fundamental to optimal performance. Lighting programs are typically designed with

changes occurring at predetermined ages and tend to vary according to the final target

market weight of the broilers.

Description

Light

Weekl

23 hours

| | 0600

Week 2

20 hours

gj 0300 till

morning

Week 3

18 hours

g} 0100 till

morning

Week 4

Natural

Week5

sun light

7) Catching Process

Feed withdrawal will take place 8 to 12 hours before processing to reduce

carcass contamination. The purpose of feed withdrawal is to empty the digestive tract,

preventing ingesta and /or fecal material from contaminating the carcasses during the

evisceration process. When birds are fasted between 8 and 12 hours, the intestine is

almost completely empty yet strong enough to withstand the evisceration process

without rupturing.

Preparation for catching

> Water must be available until the start of catching

^ Lighting will be dimmed at the time of catching. If dimming is not

feasible, the use of blue or green bulbs will clam birds and reduce

activity.

> Remove or raise all equipment that may interfere with the catch crew.

> Careful management of the ventilation system is needed during

catching to ensure adequate house ventilation.

49

Dark strip curtains hung over the doors block out light during daytime

catching. These allow birds to remain quiet and will facilitate better ventilation.

Lightweight curtains can be used to partition the house into smaller pens. This can

reduce bird stress and diminish the risk of piling. Birds will be carefully placed in

clean crates or modules.

8) Disinfection

House will be disinfected thoroughly after every production cycle and left

empty for a suitable period of time (can stop breeding cycle of disease carrier) before

a new flock is brought in. Normally about 2 week. All farm equipment disinfected

thoroughly after use and kept in a clean and dry place.

43 BUSINESS OPERATION TIME

Our business operation starts from 9.30 am - 5.30 pm. We picked this time as

it is the appropriate time for any company / business to start and close their business

daily. In the daytime, chicken will be cared and well kept by our experienced workers

to make sure the safety and health of the birds. At night, they are allowed to roam and

wander in the farm but adequate food and water are still provided. They are the most

convenient animal to breed.

Operation time:

Monday - Friday : 9.30 am - 5.30 pm

Saturday - Sunday : 10.30 am - 4.30 pm

Our operations include the process of feeding, health care and breeding.

50

4.4 CAPACITY PLANNING

Below are the lists for cost of raw material per chicken:

Raw Material

i. Day Old Chicks

Starter Feed

Pre-Grower Feed

Grower Feed

Finisher Feed

Vaccine and Medication

11.

iii.

iv.

v.

vi.

Total

Cost per chicken (RM)

1.05

0.60

1.38

1.32

1.25

0.20

5.80

Average weight of a big chicken is 2.3 kg,

Total of raw material per chicken's weight = RM 5.80 / 2.3 kg

= RM 2.52

MONTH

January-February

March-April

May-Jun

July-August

September-October

November-December

TOTAL YEAR 1

TOTAL YEAR 2

TOTAL YEAR 3

NO OF UNIT

(kg)

41,400

41,400

41,400

41,400

41,400

41,400

248,400

248,400

250,500

COST OF RAW

MATERIAL PER

CHICKEN

(RM/kg)

2.52

2.52

2.52

2.52

2.52

2.52

2.52

2.52

2.52

AMOUNT (RM)

104,328

104,328

104,328

104,328

104,328

104,328

625,968

625,968

631,260

51

4.5 TOTAL COST

MONTH

January-February

March-April

May-Jun

July-August

September-October

November-December

TOTAL

AMOUNT

104,328

104,328

104,328

104,328

104,328

104,328

625,968

4.6 MATERIAL REQUIREMENTS (INPUT)

The following are the input of the operation process.

Raw

i.

ii.

iii.

iv.

V.

vi.

Total

Material

Day Old Chicks

Starter Feed

Pre-Grower Feed

Grower Feed

Finisher Feed

Vaccine and Medication

I

Cost per chicken (RM)

1.05

0.60

1.38

1.32

1.25

0.20

5.80

52

4.7 LIST OF OPERATIONS PERSONNEL

POSITOIN

Operation Manager

Farm Workers

NO. OF PERSONNEL

1

2

4.8 SCHEDULE OF TASKS AND RESPONSIBILITIES

POSITION

Farm Workers

RESPONSIBILITY/DUTY

>• Gives a good co-operation as to

maintain the smoothness of the

operation

> To make sure the entire auto pan

feeding system, nipple drinking

system, brooding system and

control system are in good

condition.

> To make an immediate report on

machine, equipment or other

damages.

> Gives a food or other daily routine

at the applicable time.

> Always obey the rules that fixed

by company.

53


POSITION

Operation

Manager

Farm

Worker

TOTAL

NO.

1

1

3

MONTHLY

SALARY

(RM)

1,300

500(each)

2^00

EPF 12%

(RM)

156

120

276

socso2.5%

(RM)

33

25

58

TOTAL

1,489

1,145

2,634

54

4.10 MACHINE AND EQUIPMENT

a) Infrastructure Development Cost (RM)

i. Construction of access road

ii. Land clearing

iii. Fencing

iv. Main Drain System

TOTAL

6,000

10,000

15,000

8,000

39,000

b) Equipment and Machinery

ITEM

1

1.1

1.2

1.3

1.4

1.5

1.6

TYPES

PAD COOLING SYSTEM

50" fan 1.0 hp 380 V with auto shutter

Cooling Pad 6"x 24"x 60"

5'xl0' S.S Frame for Cooling Pad

Water tank with capacity of 150 gallon

Install connection of water pipe

Water pump 1.0 hp

Total for item no. 1

2 BOTH SIDE CURTAIN

Total for item no.2

NO.

8

80

8

2

1

2

TOTALCOST

(RM)

28,000

6,200

55

3

3.1

3.2

3.3

3.4

3.5

3.6

AUTO PAN FEEDING SYSTEM

Feed Hopper

336' steel pipe complete with plastic pan and

0.5 hp motor

Hand winch

Height adjusted of the auto pan feeding

system-336'

1 Gallon Drinker for day-old-chick

Square chick tray for day-old-chick

Total for item no.3

4

4.1

4.2

4.3

4.4

NIPPLE DRINKING SYSTEM

Regulator

Nipple water PVC pipe and aluminum bar

340' long.

Hand winch

Height adjusted of the nipple drinking

system-336'


5

5.1

BROODING SYSTEM

Brooder gas


6

6.1

6.2

6.3

CONTROL SYSTEM

Control system for 50" exhaust fan

Control system for water pump

Control system for Pan Feeding


7

7.1

7.2

7.3

ELECTRICAL SUPPLY

Sub-board

Lamp

Lamp post

3

3

3

3

200

200

4

4

4

4

15

1

1

1

1

50

2

23,000

14,600

4,200

8,000

56

7.4 Electrical wiring for lamp, fan and water

pump in broiler closed house.

Total item for no.7

8

8.1

GENERATOR

1 unit Gen-Set


9

9.1

WATER SUPPLY

1 unit water tank

Total for item no.9

10

10.1

10.2

Others

Trolley

Safety gear and tooling

TOTAL FOR ALL ITEM

1

1

2

12,000

10,000

5,000

200

2,000

113,200

Therefore the total costs are;

Cost of Infrastructure Development + Cost of Equipment and Machinery

= RM 39,000 + RM 113,200

= RM 152,200

57

4.11 OPERATIONS SPACE LAYOUT PLAN (BROILER CLOSED HOUSE)

a

oo

KEYS

Feed Hopper

[] 0.5 HP Motor

• Regulator

50" Exhaust Fan

Water tank

Storage and Control Room

Auto Pan Feeding Lines

Nipple Line

Plastic pan

Cooling Pad

58

4.12 OPERATION OVERHEAD

Below are the lists of estimated broiler production cost for overhead expenses:

Types Cost per chicken (RM)

i. Electricity 0.20

ii. Water 0.08

iii. Wood Shaving 0.08

iv. Catching Crew 0.15

v. Gas for brooding 0.08

Total 0.59

Total costs for operation overhead are:

= RM 0.59 X 18,000 chickens + Maintenance of Machinery + Miscellaneous

= RM 10,620+RM 250 +RM 200

= RM 11,070

NO.

1

2

3

4

5

ITEM

UTILITY

1.1 Water

1.2 Electricity

MAINTENANCE OF MACHINERY

TOOLS AND DYES

3.1 Wood shaving

3.2 Gas for Brooding

PARTIME WORKER (3 catching crew)

MISSELLANEOUS

TOTAL

AMOUNT PER MONTH

(RM)

5,040

250

2,880

2,700

200

11,070

59

4.13 OPERATION BUDGET

PARTICULARS

Fixed Asset

> Equipment and

Machinery

> Infrastructure

Development

Working Capital

> Purchase of

Material

> Salaries,

EPFand

SOCSO

> Operation

Overhead

Other Requirements

> Deposit

> Other

Expenses

TOTAL

FIXED

ASSET

COST

(RM)

113,200

39,000

152,200

MONTHLY

EXPENSES

(RM)

104,328

1,145

11,070

116,543

OTHER

EXPENSES

(RM)

5,000

2,500

7,500

TOTAL

113,200

39,000

104,328

1,145

11,070

5,000

2,500

276,243

60

H

5

61

5.0 INTRODUCTION

The most crucial before starting a new business is how to get the capital and

how the capital will be use. Financial system is basic thing or features in a business

and it is the main source to control the journey of a business.

A complete set of account which is related with the organization journey will be

prepared by the chosen Financial Manager; to financial statement every year. It will

show the profit or loss of our company, assets, liabilities and the stability and growth

of our company's financial to make it faster. Besides, financial system can give us

clear picture about return of capital that will be gain or capital investment that has

been done.

The information of financial plan is gathered on the input from the

"ministrative budget, marketing budget and operation budget.

In the financial, we have prepared the working paper, schedule and financial

itement. The statements are:

> Project cost schedule of the project

> Sources of financial

> Schedule of loan repayment

> Schedule of hire purchase

> Schedule of fixed assets depreciation

> Cash flow pro-forma

> Profit and loss pro-forma

> Balance sheet pro-forma

62

OBJECTIVE

The objective of financial plan is;

> To determine the amount of money to be invested that is the project cost.

> To identified and propose the relevant source fund

> To ensure that the initial capital is sufficient

> As a guideline for implementation

> To know whether the business is competitive or not

^ To determine the potential of the business to generate profit

> Cash outflows and cash inflows in the business project

> Hire purchase installment payment

> Loan installment payment

> Depreciation on the fixed assets

> The company's capital structure

> The total cost that we need to start the business

> Cost or paid up capital involves for starting the business

63

5.1 PROJECT IMPLEMENTATION COST SCHEDULE

RM

Capital Expenditures/Investment in Fixed Asset

Land & Building 13 8,000Furniture 2,180Office and Equipments 6,670Infrastructure Development 39,000Sign Board 500Machinery 113.200Total 299,550

Working Capital/Monthly Expenses (for 2 month)

AdministrativeMarketingOperationDay-old-chick (DOC)Total

Other Expenses

DepositCompany Registration & license FeesOther Expenses for operationBusiness Card

TotalContingencies (2%)

14,128400

24,43018.900

5,000100

2,500100

57,858

7,7007,302

TOTAL 372,410

64

5.2 SOURCE OF FINANCE SCHEDULE

Equity Contributions RM RM

Partners Contribution:

Mohamad Shukry bin Maksah

Muhammad Fairuz bin Johari

Muhd Nurfaiz bin Baharuddin

Ahmad Luqman bin Mahammed Shaihani

Sub-Total

External Sources

Bank Loan

Existing asset

Sub-Total

34,910.00

15,000.00

15,000.00

15,000.00

79,910.00

290,000.00

2,500.00

292,500.00

TOTAL SOURCES OF FINANCE 372,410.00

65

5 3 SUPPORTING SCHEDULES

LOAN OF AMORTIZATION SCHEDULE

Total Loans: RM 290,000.00

Interest rate: 4 %

Duration : 4 years / 48 months

Method : Flat Rate Method

YEAR

1

2

3

4

5

6

7

PRINCIPAL

72,500

72,500

72,500

72,500

0

0

0

INTEREST

11,600

11,600

11,600

11,600

0

0

0

TOTALREPAYMENT

84,100

84,100

84,100

84,100

0

0

0

BALANCE

217,500

145,000

72,500

-

-

-

66

FIXED ASSET DEPRECIATION SCHEDULE

Type of Asset : Furniture

Actual Price : RM 2,180.00

Economic Life: 5 years

Method : Straight Line Method

Year

1

2

3

4

5

Yearly Depreciation

436

436

436

436

436

Total Depreciation(RM)

436

872

1,308

1,744

2,180

Balance(RM)

RM 1,744.00

RM 1,308.00

RM 872.00

RM 436.00

67

Type of Asset : Equipment

Actual Price : RM 6,670.00



Year

1

2

3

4

5

Yearly Depreciation

RM 1,334.00

RM 1,334.00

RM 1,334.00

RM 1,334.00

RM 1,334.00


1,334.00

2,668.00

4,002.00

5,336.00

6,670.00

Balance(RM)

5,336.00

4,002.00

2,668.00

1,334.00

-

68

Type of Asset : Signboard

Actual Price : RM 500.00



Year

1

2

3

4

5

Yearly Depreciation

RM 100.00

RM 100.00

RM 100.00

RM 100.00

RM 100.00


RM 100.00

RM 200.00

RM 300.00

RM 400.00

RM 500.00

Balance(RM)

RM 400.00

RM 300.00

RM 200.00

RM100 .00

-

69

Type of Asset : Machinery

Actual Price : RM 113,200



Year

1

2

3

4

5

Yearly Depreciation

RM 22,640.00

RM 22,640.00

RM 22,640.00

RM 22,640.00

RM 22,640.00

Total Depreciation<RM)

RM 22,640.00

RM 45,280.00

RM67,920.00

RM90,560.00

RM113,200.00

Balance(RM)

RM 90,560.00

RM 67,920.00

RM 45280.00

RM 22,640.00

70

Type of Asset : Infrastructure Development

Actual Price : RM 39,000



Year

1

2

3

4

5

Yearly Depreciatioii

RM 7,800.00

RM 7,800.00

RM 7,800.00

RM 7,800.00

RM 7,800.00

Total Depreciatioii(RM)

RM 7,800.00

RM 15,600.00

RM23,400.00

RMS 1,200.00

RM39,000.00

Balance(RM)

RM 31,200.00

RM 23,400.00

RM 15,600.00

RM 7,800.00

-

71

5.4 PROFORMA FINANCIAL STATEMENTS

CASH FLOW PROFORMA (ANUALLY)

Cash InflowsOwners' Capital(cash)Bank LoanSalesCollection ofAccounts Receivable

Total Cash Inflows

Cash OutflowsAdministrativeExpenditure:Salary, EPF, SOCSOStationaryMiscellaneousTelephone

MarketingExpenditure:Salary, EPF, SOCSOMiscellaneous

OperationalExpenditure:Cash PurchasesSalaries, EPF,SOCSOOperation Overhead

DepositRegistration &LicensesOther ExpensesPurchase of FixedAssets - Land &BuildingPurchase of FixedAssets - Others

Yearl(2006)

79,910.00290,000.00394,496.00361,560.00

1,125,966

76,968.00600.00

1,200.006,000.00

-2,400.00

113,400.0013,740.00

132,480.00

5,000.00100.00

2,600.00138,000.00

159,050 .00

YEAR 2(2007)

--

394,496.00394,557.00

789,053.00

76,968.00600.00

1,200.006,000.00

-2,400.00

113,400.0013,740.00132,480.00

_-

2,600.00-

-

YEAR 3(2008)

--

406,725.00405,706.00

812,431.00

76,968.00600.00

1,200.006,000.00

-2,400.00

113,400.0013,740.00

495,960.00

_-

2,600.00-

-

72

Loan PaymentPrincipleInterest

Total Cash Outflows

EXCESS/(DEFICIT)

Opening CashBalance

Ending CashBalance

72,500.0011,600.00

735,998.00

389,968.00

389,968.00

72,500.0011,600.00

433,848 .00

355,205.00

389,968.00

745,173 .00

72,500.0011,600.00

776,668 .00

378,583.00

745,173.00

1,123,756.00

73

PROFORMA PROFIT AND LOSS ACCOUNTFRESH CHICKEN FARM

Proforma Profit and Loss Account for the Year Ending 31 Dec 2006RM

RMSales788,992Less: Cost of Goods Sold

Opening Stock Purchases 113,400Gross ProfitLess Expense:Administration Expenses:

Salary, EPF, SOCSO 76,968Stationary 600Miscellaneous 1,200Telephone 6,000

Marketing Expenses:Salary, EPF, SOCSOMiscellaneous 2,400

Operation Expenses:Salaries, EPF & SOCSO 13,740Operation Overhead 132,840

Financial Expenses:Interest on Loan 11,600Depreciation on Fixed Assets 32,310

Registration & Licenses 100Other Expenses 2,600

Total Expenses 393,758

Net Profit before Taxes 395,234Net Profit after Taxes 395,234Accumulated Net Profit 395,234

74

PROFORMA BALANCE SHEET ACCOUNTFRESH CHICKEN FARM

Proforma Balance Sheet for the Year Ending 31 Dec 2006

RM

Fixed AssetLand & BuildingFurnitureEquipmentsSignboardMachinery

Infrastructure DevelopmentTotal Fixed Asset

Current AssetDepositAccounts ReceivableCash

138,0001,7445,336

40090,56031.200

267,240

5,00032,936

389.968Total Current Asset 427,904

Total Asset 695,144

Owner EquityCapital (Owner's Equity)Accumulated Profit

Total Liabilities

82,410395.234

Total Equity

LiabilitiesLoans balance

477,644

217.500217,500

TOTAL EQUITY AND LIABILITIES 695,144

75

Fi

Oil

76

CONCLUSION

Based on the business plan that has been done, we have not only shown the financial

performance of this business but also the capability of the business. Because this kind

of business is rather new, our company is confident that we can penetrate the market

share.

From our observation, we also found that the Malaysian's stable economic situation

and the Malaysian's fondness to try new type of food especially Chinese will help to

encourage our business to grow. Adding to the fact that chicken's meat is lower in

cholesterol that any other meat found in the market, we are also confident that this

will also attract the health-conscious people to try this new alternative food.

The organization team for FRESH CHICKEN FARM consists of 4 dedicated,

disciplined and motivated individuals with the same aim of strengthening the

company.

As a conclusion, we strongly believe that FRESH CHICKEN FARM has a potential

in running this business and has the competitive edge to succeed.

77

I ,\ I)

78

The environment of location before the project being proceeds

4- The location under construction.

4- Our products.

Mohammad Shukry B. Maksah

No. 41, Jalan Sri Damak 50,

Taman Sri Andalas,

41200 Klang

Selngor

To Whom It May Concern.

Dear Sir,

Agreement on using land at Lorong Sarkawi, Jalan Kebun, Klang Selangor.

I am, Siti Bt Hj. Abdul Rahman as the owner of the land located above, agree to let

my niece to develop that unoccupied land to open a broiler house with some

incentives as in return. I will not be accused if they had a problem or involved in

problem.

Thank You,

Your Faithfully

SitiBtHj. Rahman

(No. VC: 4297581)

October 2, 2005

FRESH CHICKEN FARM

Lot 3307, Batu 7, Lorong Sarkawi,

Jalan Kebun,

42450, Klang

Selangor Darul Ehsan.

Dear FRESH CHICKEN FARM,

Contract Farming With FRESH CHICKEN FARM At Jalan Kebun, Klang,Selangor

We are please to inform you that we have accepted your proposal to rear 18,000 birds/ flocks about 1 houseon a piece of land specifies above with the concept of new broiler closed house.

You will have to construct the chicken's house according to Pertanian Pertiwi Sdn. Bhd. Specifications andwill sign a Contract Farming Agreement with Pertanian Pertiwi when the construction of the chicken houseis completed.

The company will then supply you day-old-chicks and feed according to the agreement that will be signedwhen you have complete construct your chicken house. We will market all the birds when they reach marketsize.

Thank you.

Yours faithfully,

Mr. Liau Chai Peng

Branch IManager(Klang)

Pertanian Pertiwi Sdn. Bhd.

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{•TELEKOM^SSK MALAYSIA

TP 69A

PERMOHONAN UNTUK PERKHIDMATAN PERNIAGAAN

(Telefon-Datel-Teleteks-Tetefax-Teleks)

Rujukan

NAMAPENUH I I 1 I I I I 1 I I ' 1

(Seperti dim K/Pengenalan/Paspot/Sljil Daftar Perniagaan)

Jika perkhidmatan adalah di bawah nama Peiniagaan/Kerajaan/Kedutaan,dll., nyatakan Nama Pengguna dan Pangkat.

Untuk KegunaanPejabat Sahaja

NAMAPENUHPENGGUNA

PANGKAT

Kod KategonPelanggan

1 I I I 1 I I I I

1 1 1 1 I 1 I J1 I I I I

No. Kad Pengenalan

No. PendaftaranPerniagaan

J I

No. Paspot

NegaraI I I I I 1 I

I I I IKod Negara

ALAMAT PERSURATAN : No.

No Lot/No. Pangsapuri :

Tingkat • I

Nama Jalan :

Tmn./Seksyen :

Peti Surat :

I I I 1

II I

Bangunan . I I_J LJ L

I I I I I I I I I I

L _ J I I I I I I I I I I 1 1 I l

Bandar :

No. I

I I I I I I

I I I I I I

Poskod :

Negen :

I I I I I

I J I

J I

Bangunan :

Nama Jalan :

Tmn./Seksyen ;

Poskod :

Bandar : L

ALAMAT PEMASANGAN (Jika berlainan daripada alamat persuratnn) '

J Tingkat I I I No. Lot/No. Pangsapuri : I I I I I I

I ! I I I I I I I I I J I I I I I I I I

I I I I I I J

I 1 _L_ J I L I I I I

1 I I

J |.J LJ Negeri : 1 I I I I

TANDAKAN ) DALAM KOTAK ' <i BERKENAAN Lihat Sebelah

PERKHIDMATAIM DIPERLUKAPJ

TALIAN IBUSAWATTERUS ATD (ISO) SAMBUNGAN SELARI RAOAS TELEFON TAMBAHAN

Bil TalianOikehendaki

PERKHIDMATAN

P A B X

KEYTELEFON

Jems/Model

BilSambungan

BilStesen

Bil NomborUtama

Bil. NorpborAuxiliary

PERKHIDMATAN TELEMATIC

PERKHIDMATAN

DATEL

TELETEKS

TELEFAX

Jems/ModelRadas

Jems/ModelModem

Catatan "

Menggunakan Nombor Telefon yang sediada J 1 I I" I I I

PERKHIDMATAN

TELEKS

Jems RadasCadangan Kod Jawab-Balik

[ I I

KEMUDAHAN TAMBAHAN/CIRI-CIRI KHAS DIKEHENDAKI .

CATATAN

Tahun Bulan Han

Tandatangan Pemohqn

TANDAKAN ( ̂ ) DALAM KOTAK YANG BERKENAAN

Jika menggunakan radas sendirf, sila kemukakan surat pembekal. Cuma radas Kelulusan STM/JTM (Kswasolia) boleh digunakan.

PNA. 42PEJA&AT PENDAFTAR PERNIAGAAN

Permohonan Kelulusan Nama Perniagaan(Tiada Bayaran Dikenakan)

Saya memohon menggunakan salah satu nama-nama perniagaan dibawah:

( a )

( b )

( c )

* Nama dan Alamat Pemiiik / Pekongsi * No. Kad Pengenalan & Wama((.junakan lampiran lamjika pemiiik lebih 3 orang)

(a)Nama: Baru: .

Alamat: Lama:

(b)Nama : Baru:

Alamat: Lama:

(c)Nama : Baru:

Alamat: Lama:

* Jenis perniagaan dijalankan :

# Tarikh * Tandatangan Pemohon :

Nama :

No. K/P :

# No. Rujukan:

# No. Rujukan:

# Catatan :

Tarikh:(

Penolong Pendaftar Perniagaan+ Sila lihat syarat kelulusan dimuka sebelah. Kuala Lumpur* Pemohon hendaklah melengkapkan ruangan-ruangan ini.# Ruangan ini dibiar kosong.

Syarat-syarat Kelulusan

1. Permohonan nama perniagaan yang tidak meraenuhi syarat di bawah akan ditolak:

a. Nama perniagaan tidak bersesuaian dengan jenis perniagaan yang dijalankan.b. Nama yang dipohon telah digunakan oleh peniaga lain.c. Menggunakan nama diri yang bukan nama sebenar pemilik.d. Menggunakan perkataan yang dikawal oleh Pendaftar.e. Nama yang tertakluk di bawah Kaedah Pendaftaran Perniagaan 1957.

2. Nama yang diluluskan tidak boleh dipinda/ditambah perkataan atau huruf.

3. Kelulusan ini tidak boleh dipindah milik kepada orang lain.

4. Permohonan baru perlu dibuat jika perniagaan tidak didaftarkan selepas tamat tempoh kelulusannama perniagaan.

5. Permohonan yang mempunyai perniagaan lain yang telah tamat tempoh laku Sijil PerakuanPendaftarannya hendaklah memperbaharui Sijil Perakuan itu dahulu atau memfailkan Borang ' C .

6. Pemilik/Pekongsi mestilah bermastautin di negeri di mana perniagaan dijalankan.

KELULUSAN INI MENJADI BATAL JIKA SATU ATAU SEMUA SYARAT DI ATAS TIDAKDIPATUHI.

KAEDAH-KAEDAH PENDAFTARANPERNIAGAAN 1957

(KAEDAH 3)

PENDAFTARAN PERNIAGAAN

UNTUK KEGUNAAN PEJABATNO.PERAKUAN

DIBIARKAN KOSONG

BORANGA

f>ENDAFTARAN PERNIAGAAN,

Saya/Kami yang bertanggungjawab menyerahkan butir-butir berikut mengenai perniagaan yang tersebut di bawah miuntuk didaftarkan.

Saya/Kami menyerahkan Wang Kiriman/Wang Tunai sebanyak RM25/RM50 untuk bayaran pendaftaran dan untuk^erakuan Pendaftaran.

A. MAKLUMAT PERNIAGAAN

1. NAMA PERNIAGAAN

2. TARIKH MULA BERNIAGA 3. PERJANJIAN PERKONGSIAN (PILIH SATU)

ADA (LAMPIRKAN SURAT PERJANJIAN)

TARIKH

TIADA

4. ALAMAT TEMPAT UTAMA/PENGKALAN PERNIAGAAN

4.1. BANDAR 4.2. POSKOD 4.3. NEGERI (KOD)

.5. ALAMAT SURAT-MENYURAT (JIKA BERLAINAN DARI DI ATAS)

15.1. BANDAR 5.2. POSKOD 5.3. NEGERI (KOD)


(KAEDAH 3)


B. MAKLUMAT'CAWANGAN

UNTUK KEGUNAAN PEJABATNO PERAKUAN

DIBIARKAN KOSONG

BORANGA

ALAMAT CAWANGAN

1. BANDAR 1.2. POSKOD 1.3. NEGERI(KOD)

ALAMAT CAWANGAN

.1 . BANDAR 1.2. POSKOD 1.3. NEGERI(KOD)

ALAMAT CAWANGAN

.1. BANDAR 1.2. POSKOD

•

1.3. NEGERI(KOD)

2


(KAEDAH 3)


C. IVIAKLUMAT PEMILIK

UNTUK KEGUNAAN PEJABATNO. PERAKUAN

DIBIARKAN KOSONG

Nota: Tiap-tiap pemilik hendaklah mengisibutir-butir bahagian ini dalamhelaian berasingan.

BORANGA

1. NAMA PEMILIK 2. JANTINA

LELAKI

PEREMPUAN

3. NO. PENGENALAN DIRI

KAD PENGENALAN(BARU)

PASPORT POLIS TENTERA

KAD PENGENALAN (LAMA)

4. WARNA

BIRU MERAH LAIN-LAIN

5. TARIKH LAHIR

6. ALAMAT KEDIAMAN

6.1. BANDAR

7. BANGSA

MELAYU

CINA

INDIA

BUMIPUTERA SABAH

BUMIPUTERA SARAWAK

LAIN-LAIN(SILA NYATAKAN)

6.2. POSKOD

6. KERAKYATAN

MALAYSIA

PENDUDUK TETAP(NYATAKAN NEGARA ASAL)

10. TANDATANGAN PEMILIK

6.3. NEGERI (KOD)

9. PEMILIKAN

KETUANPUNYAANTUNGGAL

KONGSI UTAMA

KONGSI BIASA


(KAEDAH 3)



DIBIARKAN KOSONG

t). MAKLUMAT JENIS PERNIAGAAN

UNTUK KEGUNAAN PEJABATKOD JENIS PERNIAQAAN

DIBIARKAN KOSONG

BORANGA

I. JENIS PERNIAGAAN

2. TARIKH


(KAEDAH 3)


E. PENGESAHAN OLEH SEKUTU-NIAGA


DIBIARKAN KOSONG

BORANGA

Saya/Kami yang bertandatangan di bawah ini mengesahkan bahawa segala kenyataan yang dibuat dalam borang ini

adalah tepat dan mengaku bahawa saya/kami adalah sekutu dalam perniagaan bernama

NAMA PENUH NO. KAD PENGENALAN/WARNA TANDATANGAN/CAP IBU JARI KANAN

Saya mengaku bahawa tandatangan/cap ibu jari kanan di atas telah diturunkan pada akuan di atas ini di hadapansaya setelah saya berpuashati bahawa orang yang menurunkan tandatangan/cap ibu jari kanan itu adalah sebenarnyaDrang yang namanya tersebut dalam akuan itu dan ia/mereka faham maksud akuan itu.

Bertarikh di. .pada. .haribulan . tahun.

NAMA :

JAWATAN :

ALAMAT :(TANOATANGAN DAN COP RASMI

PEGAWAI PENGESAH)

Catatan: Pengesahan di atas hendaklah disaksikan oleh - Ahli Parlimen atau Ahli Dewan UndanganNegeri, Hakim, Majistret, Pegawai Kumpulan Pengurusan dan Profesional, Peguambela atauPeguamcara, Penghulu, Penggawa, Jaksa Pendamai (J.P), atau Pesuruhjaya Sumpah.

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991BORANG PENDAFTARAN AH LI

KWSP 3 (AHL)

10. MAJIKAN.NO. AHL1:

KEGUNAAN KWSP

fama Ponuii I'ekcrja:

NO. Kad Pengehalan: Jantina:

o. K/P Lamu/Paspot: Tarikh Lahir: _—

A'arganegara: Keiurunan •

UNTUK KEGUNAAN KWSP j

I KWSP 3 [ J

I Mama Ringkas

j T'/tangan Pengesah:

j Jaw at an:

I'arikh:

KWSP 4

ku dan m o n i v s a h k a n b a h a w a bu{'::- S:i\a m c n e a k u bahawa bul i r -bul i r

.-:\':;;ai J; aia^ -idaiah beiul dan ')cn;:r vanu tcrcai!il di alas adalah bctul |

u! iVm..'. liul..:' boi iau dan kcdua C'-.i|i d a n b e n a i m c n g i k u t K a J

CAP IBU JARI AJHLI

K1RI

i b i i .!.;! in'>; i • - i i i n d i ; i i r ' i n k ; i ' ! d i h a d a p a n say a.

Tandatangan: .(Majikan. Wakil Majikan atau Pegawai KWSP)

Jawatan:

No. K/Pengenalan:

Tarikh:

reii;:en<iian S

Tandatangan:(Pekerja)

Tarikh:

i ' i K M • • • < - • v ' i . - v ' - - : A •••d'P i \ K A N i-:.AI") i ' l • N ( , I ' . N ; \ L A \ .

KANAN

L1HAT DI BFLAKANG

MA A1ILI':

LA.MAT All LI:

.i A NIC i A N Dl i ' L K A I K A N

TUAN/PUAN

yNDAITARAN KWSP 3

lAdalah dimaklumkan pecniohonan Tuan/Puan untuk menjadi ahli KWSP telah diterima dan kad keahlian akan dihantar

epada Tuan/Puan sebaik sahaja urusan pendaftaran telah dise inpuniakan.

ckian.

f.p l'engernsi HksekutifLembaga Kunipulan Wang Simpanan Pekerja.

tarikh:

ALAMAT TUAN/PUAN

NO. TELEFON

ALAMAT WARIS

TERDEKAT:

POSKOD

BANDAR

NEGERI

NO. TELEFON

POSKOD

BANDAR

NEGERI

PERHATIAN:

SEKIRANYA TUAN/PUAN TELAH BERPINDAH ALAMAT, SILA ISIKAN BORANG KWSP 1866 DAN HANTARKE PEJABAT KWSP YANG BERHAMPIRAN DENGAN TEMPAT TINGGAL TUAN/PUAN.

Sava

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991BORANG PENAMAAN

No. K./P

KWSP4(A>!L)

dan No. Ahli

(NAMA AHLI)

menamakan mdividu seperti disebutkan di bawah un'uk menerima simpanan KWSP apabila berlaku kcniatiankeatas diri sava.

NAM A NO. K.P/SURAT BERANAK PERTALIAN BAHAG1AN

JANGAN DICERAIKAN

SILA LIHAT DI BELAKANG

NAMA AHLI:

ALAVIA'I AHLI:

TUAN/PUAN

PENAMAAN KWSP 4

Adalah dimaklumkan penamaan Tuan/Puan bertarikh

l.Telah didaftarkan

2.Tidak dapat didaftarkan kerana belum mencapai 18 tahun/borang tidak lengkap.

Sekian.

b.p Pcnge.-usi EksekutifLenibaga Kumpulan Wang Simpanan Pekcrja.

Tarikh:

Penamaan ini bertarikh Hniibulan 20 membaf.ilkan penainaan yang tcrdahulu

AKUAN SAKSI

Saya dengan ini mengcsahkan kenyataan di alas telah dibuatoleh ahli dan cap ibu jarinya telah diturunkan di hadapan sava.

Nama penuh saksi:

No k p saksi

Pekerjaan:

Alamat saksi:

CAP IBU JAR! AHLI

Tandatangan saksi.

Tarikh,

UNTUKKBGUNAANKWSPSAIIAJA

TARIKH TERIMA 'IARIKH DIDAFTAR

KIRI KANAN

PERHATIAN:

i) S e k i r a n y a c a p ibu j a r i k i r i / k a n a n r o s a k. si I a

tandaiangani pada scbelahan cap ibu jari lersebut

li) Jika seorang ahli Kumpulan Wang yang beragama

Is l am mat i d e n g a n m e m b u a t p e n a m a a n m e n g i k u t

Pe ra tu ran -pe ra tunn mi , orang atau bebeiapa orang yang

d inamakan itu hendak lah m e n e r i m a kicdi t ahl i \ a n g

mati itu sebagai s eo rang wasi dan bukannya sebagai

benef is ian dan hendaklah membahagi-bahagikan kredit

itu mengikut Undang-undang Islam.

KEGUNAAN KWSP SAHAJA

KP

HURUFAWALAN

NAMAAHU

MOD PEMBAYARAN

WARAN

DRAF8ANKASING

ARAHAN1 BAYARAN

KREDITKEAKAUNBANK

1

2

3

4

DISEMAKOLEH

PEGAWAIPENYEMAK

NO K/TGN

U_LTARIKri

DISAHKANOLEHPEGAWAIPENGESAH

TARIKH

DILULUSKANOLEH:PEGAWAIPEI.U1.US1

NO K/TGK

I I ITARIKH

INO

IK/TGN

I I I

DILULUSKANOLEHPEGAWAIPELULUS2

1TARIKH

NO K/TGN

1 1 1

1. NOMBORAHU

! I I3 NOMBORKADPENGENALAN7DIGIT

• I I I I

BUTIRAN AHLI

2 NOMBOR KAD PENGENALAN12 DIGIT

I II I4 NOf/BORPOUS/TENTERA/PASPORT/DSB

I I I I I |

I

I5. NAMA MENGIKUT KAD PENGENALAN/PASPORT

i I II I I

II

I II I

T1

11 II 1

6 SEKTOR KERAJAAN 7.JANTINA

BEKERJASENDIRI

KERAJAAN

SWASTA

TIDAK BEKERJALILFLAKI PEREMPUAN

KETURUNAN 9 AMAUN YANG DIPOHON• RINGGIT MALAYSIA

1X11UJSEN

10 ALAMATAHLI

[ TTTTTT I T n

r i IT T T l I 1 1 I 1 1 I I I I I I IPOSKOD BANDAR

LJLLXXlLi IT 1NEGERI

rTXT"rrrT~rn~rT

I T I I I I 1

TTT11. NOMBOR TELEFON PEJABAT

n T I I I INOMBOR TELEFON RUMAH/EIMBIT

L l I I I I F T ZADALAH SAYA DENGAN INI MENGAKU JAN Jl SEPERTIBERIKUT1 MEMATUHI SEMUA SYARAT YANG DIKENAKAN OLEH LEMBAGA Dl BAWAH SKIM IN' DAN MEMAHAMIDENOAN PEMIUHAN INI LEMBAGA TIDAK AKAN

BERTANGGUNGJAWAB KE ATAS APA APA KLEMBAGA Dl ATAS KERUGIAN TERSEBUT

2 APA-APA AMAUN YANG OIPINDAHKAN TIDAK TERMASUK DALAM PENAMAAN SAYA3 SAYA JUGA FAHAM BAHAWA SAYA TIDAK BOLEH MEMBATALKAN PSRVOHONAN INI

12.

JENIS PENGELUARAN

NOMBOR AHLI

CAP IBU JARI KIRI

DAN KANAN AHLI

(MESTI DITURUNKAN

DENGAN TERANG

DAN PENUH

MENGGUNAKAN

PAD CAP IBU JARI

BERWARNA HITAM)

TARIKH

• NOMBOR

KIRl KANAN

13. UNTUK DIISI OLEH INSTITUSI PENGURUSAN DANA (IPD)

KOD INSTITUSI PENGURUSAN DANA (RUJUK PANDUAN MENGISI BOR« NG)

NOMBOR AKAUN/NO RUJUKAN PEMOHON LHH

SAYA DENGAN INI MENGESAHKAN MAKLUMAT PDviOHON Dl ATASi i i i i i i i i

TANOATANGAN NAMA PEGAWAI COP RASMI

TARIKH

PANDUAN UNTUK MENGISI BORANG KWSP 9F (AHL)PEMBERITAHUAN PEMINDAHAN KREDIT UNTUK SKIM PELABURAN

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG BORANG PERMOHONAN MESTILAHDIPENUHI DENGAN HURUF BESAR.

Nombor Ahll

Isikan sata digit di setiap ruang dengan didahului oleh dig.t '0' jika perlu seperti contoh di bawah

Contoh 1234567

1. NOMBOR AHL!r — r

3 4 , 5 6

2. Nombor Kad Pengenalan 12 Digit

Isikan nombor Kad Pengeiialan 12 digit tuan/puan Jlka tuan/puan belum memiliki Kad Pengtnalan 12digit, kosongkan rtiangan ini

2. NOMBOR KAD PENGENALAN

Contoh 610701-02-6157 6 1 0 1 7 , 0 1 0 1 I 5


Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah

a) 1234567

b) A 1234567

c) K 1234567

d) H 1234567

3 . NOMBOR KAD PENGENALAN 7 DIGIT1

3 4 , 5 6

3 4

3 4

3 , 4

5

5

6

6

4- Nombor Polis/Tentera/Pasport/Dsb

Isikan Nombor Polis/Tentera/Pasport/Dsb termasuk huruf awalan, seperti contoh di bawah

4. NOMBOR POLIS/TENTERA/PASPORT/DSB

a' I 1234567

b) T 1234567

* S 6 | 7

5 (5 7

5. Nama Mengikut Kad Pengenalan/Pasport

Tuliskan nama tuan/puan seoagaimana yang tercalat dalam kad pengenalan tuan/puanJlka sama menglkut kad pengenalan ialah Norman bin Abdullah sila tuliskan nama seperti di bawah

5. NAMA MENGIhUT KAD PENGENA1 AN/PASPORI

N O R ' M ' A I N N B D H1_

6. Sektor Pekeriaan

Tandakan ( V ) di dalam ruang yang disediakan. Jlka tuan/puan bekerja dalam sektor swasta, tandakan( V ) dalam ruang berkenaan sepertl di bawah :

?• SEKTOR PEKERJAAN

BEKERJA SENDIRI I

KERAJAAN

SWASTA

TIDAK BEKERJA

7- Jantina

Tandakan jantina tuan/puan dengan ( V ) dalam ruang yang disediakan. Jika lelaki, tandakan (V) di ruangyang berkenaan seperti di bawah :

7. JANTINA LELAKI PEREMPUAN

8. Keturunan

Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, Isikanseperti di bawah :

8. KETURUNAN 1

MelayuCinaIndiaLain-lain

1234

BidayuhKadazanIban

567

9. Amaun Dipohon

Isikan satu digit di setiap ruang dengan didahului oleh digit-digit '0' jika perlu. Jika amaun yang dikehendakioleh tuan/puan untuk pemindahan pelaburan (setelah berunding dengan IPD) adalah RM13,170.00, isikanruangan yang berkenaan seperti di bawah :

9. AMAUN DIPOHON

RINGGIT MALAYSIA SEN

0 0 0 0

10. Alamat Ahli

Tuliskan alamat surat menyurat tuan/puan dengan lengkap. Jika alamat surat menyurat tuan/puan adalahLot 10 Kg Parit Kadir Timur, Bukit Pasir, 84300 Muar, Johor Daru) Takzim, sila penuhl seperti berikut :

10. ALAMAT AHLI

L

T

O

I

T

M

POSKOD

8 4 3

NEGERI

J O H

U

0

o

1

R

0

0

R

B

K

U

G

K

BANDAR

M

D

U

A

A

R

I

R

U

P

T

A

L

R

P

T

I

A

A

T

S

K

I

Z

K

R

I

A D I R

M

11. Nombor Telefon

Isikan nombor telefon di ruangan yang disediakan dl bawah :Contoh : Nombor Telefon Pejabat : 07 - 9859450 Nombor Telefon Rumah/Blmbit : 016 - 2070158

11. TELEFON PEJABAT8 _ L L L L I I I

TELEFON RUMAH/BIMBIT

- ! 2 0 7 0 1 5 8

12. Jenis Fengeluaran. Nombor Ahli. Nombor Kad Pengenalan dan Cap lbu Jar!

Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanantuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jarl berwarna hltam.

13. BUTIRAN UNTUK DIISI OLEH INSTITUSI PENGURUSAN DANA

i. Kod Instltusi Pengurusan Dana

Isikan kod yang telah diperuntukkan oleh KWSP kepada Institusl Pengurusan Dana (IPD) :Contoh : Kod 'AIM Unit Trust Bhd" ialah 007

Isikan seperti berikut di kotak yang berkenaan D 0 0

Nombor Akaun / Nombor Rujukan Pemohon

Tullskan nombor akaun / nombor rujukan yang diperuntukkan oleh IPD kepada pemohon.Contohnya : Jika nombor akaun pelaburan pemohon ialah 123456789100001, isikan ruanganseperti di bawah :

LI 8 9 1 0 0 0 ' 0

HI. Pengesahan Nombor Pollsl / Nombor Rujukan Pemohon

Turunkan tandatangan, tuliskan nama pegawai dan cop rasmi IPD serta tarikh pengesahan di ruanganyang disediakan.

n

NAMA

NO. AHLI TEL:(P) (R),

1.0 PENTING

11 Borang permohonan yang telah lengkap diisi hendaklah diserahkan kepada Institusi Pengurusan Dana(IPD) yang dplih

1 2 Salman dokumen hendaklah disahkan oleh pegawai Institusi Pengurusan Dana (IPD) yang dipilih

1 3 Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam Tuan/puan hendaklahmenurunkan cap ibu jan kin dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Janberwarna hitam

1 4 Tuan/puan hendaklah memastikan dokumer dokumen yang disertakan bersama-sama dengan borangpermohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples)

1 5 Semua sahnan fotostat dokumen hendaklah menggunakan kertas saiz A4

1 6 KWSP berhak menolak mana-mana permohonan yang tidak lengkap

2.0 DOKUMEN UTAMA

Tandakan (V ) dalam kotak yang berkenaan

2 1 Borang permohonan KWSP 9F(AHL) - 3 Salman

(1 sahnan disimpan oleh IPD dan 2 salinan untuk kegunaan KWSP)

2 2 Salman Kad Pengenalan ajau

Salman Kad Pengenalan Polis/Tentera danSurat Pengesahan Majikan menyatakan nombor Kad Pengenalan Awam aannombor Polis/Tentera merujuk kepada orang yang sama

Tandatangan Ahli

Tandatangan Penenma

Tankh

Tankh

KUMPULAN WANG SIMPANAN PEKERJA1OGOS2001


KPD E

HURUFAWALAN

NAMAAHU

MODPEMBAYARAN

WARAN

DRAFBANKASING

ARAHAN8AYARAN

KREDITKE AKAUN BANK

1

23

4

JENIS AKAUN

KONVENSIONAL

AL-WADIAH

12

PENERiMABAYARAN

AHLI

INSTlTUSIPENGAJIANTiNGG!

INSTITUSIPEMBERIPINJAMAN

1

2

3

DISEMAKOLEH:PEGAWAIPENYEMAK

CAW UNIT

1

NO. K/TGN

TTTI

TARIKH.

JENIS PENGELUARAN YANG DIPOHON: SILA TANDAKAN ( V ) Dl KOTAK YANG BERKENAAN

1. JENIS PENGELUARAN

1

2

PENDIDIKAN

PENDIDIKAN ANAKAHU

2.NOMBORAHLI

4. NOMBORKADPENGENALAN7DIGIT

6. KETURUNAN•

BUTIRAN AHLI

3, NOMBOR KAD PENGENALAN 12 DIGIT

rrrr\ i I-I i i -i i

5. NOMBOR POUS/TENTERA/PASPORT/DSB

niTTTT I I I ! I I

7.JANTINA

LELAKI

PEREMPUAN

8. NAMA MENGIKUT KAD PENGENAUN PASPORT

I I I I I I I I I I I9.ALAMATAHU

i n i i nPOSKOD BANDAR

TTTTl rrrrNEGERI

r m i i i i i i i i i TTITTTT M I N I

10. NOMBOR TELEFON PEJABAT NOMBOR TELEFON RUMAH/BIMBIT

I I I I I I I I

11. YURAN PENGAJIAN AHLI/ANAK AHLI

RINGGIT MALAYSIA

I I I I I ISEN

12

I I I

. AMAUN DIPOHON UNTUK AHLI/ANAK AHLI

RINGGIT MALAYSIA

I I I I ISEN

I

13. BAKIFINJAMAN PENDIDIKAN AHLI/ANAK AHLI 14. JENIS PEMBAYARAN

RINGGIT MALAYSIA

I I I I I ISEN

IWARAN

DRAFBANKASING

ARAHANBAYARAN

KREDITKE AKAUN BANK

BUTIRAN AKAUN BANK (SEKIRANYA PEMBAYARAN DIBUAT KEPADA AHLI)

16. KOD BANK 16. NOMBOR AKAUN BANK AHLI

i i ' i i i i i i i i i i i i i i i i i i i n

17. JENIS AKAUN

KONVENSIONAL

AL-WADIAH

PEMBERITAHUANDISAHKANOLEH

PEGAWAIPENGESAH

NO K/TGN

TARIKH

DILULUSKANOLEHPEGAWAI PELULUS1

NO K/TGN

TARIKH

PEGAWAI PELULUS 2

NO K/TGN

TARIKH

BUTIRAM PELAJAR (ANAK AHLI) (SEKIRANYA MEI1OHON UNTUK PENDIDIKAN ANAK)

niErn18 NAMA PELAJAh Mf-Nbirs(JT KAD PENGENALAN

TTTTTTT

19 NOMBOR KAD PENGENAIAN 12 DIGIT

20 HUBUNGAN AH J DENGAN PELAJAR ANAK AMAKTIRI ANAK ANGKAT

BUTIRAN LAIN

i21 JAMA DAN CAWANGAN INSTITUSI PCNGAJIAN TINGGI

Ii I I I I I I

22 PERINGKATPENGAJIAN P I 23 TAHUN PENGAJIAN H I 24 LOKASI PENGAJIAN •25 NAMA PAN CAWANGAN INSTITUSI DFMBERI PINJAMAN

1X1 II

1 SAYA DENGAN INI MEMOhON UNTUKMENGELUA^KAN KREDITSAYADI KWSPtv'ENURUTPERUNTUKANAKTAKWSP 1991 SAYA JUGAAKANPATUHKEHLNDAK SEKCYCN 54(6)(G) PERUNTUKAN AKTAKWSP 1991

2 SAYA MEMBFt ARK AN KWSP MEMBUAT BAYARAN TER JS KEPADA INSTITUSI PFNGAJIAN TINGGI ATAU PEMBERI PIN JAMAN Dl MANA YANGBERKtNAAN

26

JENIS PENGi-LUARAN

NOMBOR AHII

CAP IBU JARI KIRI

DAN KANAN AHLI

(MESTI DITURUNKAN

DENGAN TERANG

DAN PENUH

MENGGUNAKAN

PAD CAP IBU JARI

BERWARNA HITAM)

TARIKH _

I • NOMBOR

KIRI KANAN

PANDUAN UNTUK MENGISI BORANG KWSP 9 H fAHLlPENGELUARAN PENDIPIKAN ANAK

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAHDIPENUHI DENGAN HURUF BESAR.

1.

2.

Jenis Pengeluaran Yang Dipohon

Tandakan ( V ) dlmana berkenaan 1. JENIS PENGELUARAN

1.

2.

PENDIDIKAN AHLI

PENDIDIKAN ANAK AHLI

Nombor Ahli

Isikan satu digit di setiap ruang dengan didahului oleh digit '0' jika perlu, seperti contoh di bawah

Con ton : 01234567

2. NOMBOR AHLI1 [_2 3 4 5 6 7


Isikan nombor Kad Pengenalan 12 digit tuan/puan. Jika tuan/puan belum memiliki Kad Pengenalan 12digit, kosongkan ruangan ini :

Contoh : 610701 - 02 - 6157

3. NOMBOR KAD PENGENALAN 12 DIGIT

o | 7 | o o


4.1 Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf avvalan, seperti contoh di bawah:


a) 1234567

5 .

1 i 2 [ 3 ' 4 fs \ 6~J~7

b)

c)

d)

Nombor

A

K

H

1234567

1234567

1234567

Polis/Tentera/Pasport/Dsb

3 4 1~5 ] 6 F 7

[K T]2

1 I 2 ! 3 4 | 5 6 [ 7

Isikan Nombor Kad Pengenalan Polis/Tentera/Pasport/Dsb tennasuk huruf awalan, seperti contoh di bawah:

5. NOMBOR/POLIS/TENTERA/PASPORT/DSB

HIDa)

b)

I 1234567

T 1234567

6. Keturunan

Isikan ruang dengan menglkut kod keturunan di bawah lnl. Jika tuan/puan berketurunan Melayu, isikanseperti di bawah :

567

6. KETURUNAN| 1

MelayuCinaIndiaLatn-lain

1234

BidayuhKadazanlban

7.

Tandakan jantina tuan/puan cU ngan ( \ ) dalain ruang yang disediakan Jika lelaki tandakan ( V ) di ruangyang berkenaan seperti di bawah

7 JANTINA

IELAKI

I'F REMPUAW

Nama Mengikut Kad Pengenalan/Pasport

Tuhskan nama tuan/puan sebagaimana yang tercatat dalam kad pengenalin tuan/puanJika sama mengikut kad pengf nalan ulah Norman bin Abdullah sila tuhskan nania seperti di bawah

8. NAMA MENGIKUT KAO I 1 NGENAI AN/P<\SPORT' ] O | R T M7~A^~N I ] B 1 N A B | D U L ] L |~A ' H ' ^

9. Alamat Ahli

Tuliskan alamat surat menyural tuan/puan dcngan lengkap Jika ilamat surat menyurat tuan/puan adalahLot 10 Kg Parit Kadir Timur Bukit Pasir 84300 Muai Johor Darul Tak/im Sila penuhi seperti berikut

9 ALAMAT AHLIL i O T 1 0 K[ G P A R I T r K A

1 I I M | U I R I

POSKOD~8 4 ' 3}

NEGERI

^ , HTOI R!

_B J U K I I

B A N D A R

M1 U [ A I R

P A S 1 R 11 1

j Q _J.T D

10 . Nombor Telefon Pejabat & Nombor Telefon Rumah

Isikan nombor telefon pejabat dan uimah di ruangan yang disediakan di bawahContoh Nombor Telefon Pejabat 07 9859450 Nombor Telefon Rumah/ Bimbit 0 1 6 - 2 0 7 0 1 5 8

10. TELEFON PEJABA10 ' 7 r q T 8 T ¥ " 9 ^ 4 5 0

TELEFON RUMAH 'BIMB1T0 i 1 ' 6 2 , 0 7 0 1 5

11 Yuran Pengajian Ahli/Anak

Isikan satu nombor untuk Uap tiap satu ruangan Nombor kosong (0) di hadapan perlu dituhskan dalamsemua ruangan yang tidak dipenulu Jika yuian pengajian t u a n / p u a n atau anak t u a n / p u a n adalahRM12 000 00, isikan ruangan \ang bei kenaan sepeiti di bawah

11 MIRAN I'ENGA.JIAN AHLI/ANAK

RINGGIT MALAYSIA T SEN

0 0 1J 2 l 0 0 I 0 Jo_O I

12. Amaun Dipohon

Isikan satu nombor untuk tiap-tlap satu ruangan. Nombor 'kosong' (0) di hadapan perlu dituliskan dalamsemua ruangan yang tidak dipenuht. Jika tuan/puan memohon RM 10,000.00, isikan ruangan yang berkenaanseperti di bawah :

12. AMAUN DIPOHON

RINGGIT MALAYSIA SEN

_OJ 0 | 1 | 2 j 0 | 0 J 0 | 0 0

13. Baki Piniaman Pendidikan Ahli/Anak Ahli

Isikan satu nombor untuk tiap-tiap satu ruangan. Nombor 'kosong' (0) di hadapan perlu dituliskan dalamsemua ruangan yang tidak dipenuhi. Jika tuan/puan memohon RM10.000.00, isikan ruangan yang berkenaanseperti di bawah :

13. BAKI PINJAMAN PENDIDIKAN AHLI/ANAK AHLI

RINGGIT MALAYSIA I SEN

[ Oj_ 0J_1 | 0 0 0 j 0 ' 0 I 0

14. Jenis Pembayaran

Tuan/puan boleh memilih salah satu cara pembayaran sepcrti berikut . Jika tuan/puan memllih Kredit KeAkaun Bank, sila tandakan ( V ) di ruangan yang berkenaan :

14. JENIS PEMBAYARAN

ARAHAN BAYARANWARAN

DRAF BANK ASING KREDIT KE AKAUN BANK

IS. Kod Bank

16.

Isikan kod bank tuan/puan seperti contoh di bawahJika kod bank tuan/puan adalah Maybank

15. KOD BANK

RHB BankMaybankBumiputra CommercePublic BankHong Leong BankHong Leong FinanceAffin BankEON Bank

Nombor Akaun Bank

010 20 30 405060 70 8

Arab Malaysian Bank - 09Alliance Bank - 10Southern Bank - 11Utama Bank - 12Bank Muamalat 13Arab Malaysian Finance • 14BanL Islam - 15

Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah

16. NOMBOR AKAUN BANK

1 4 6 . 8 0

17. Jejiis Akaun

I s i k a n )( m-- a k a u n vans.1 l ipihl nh 1 in p u i'i i k i m a n p u tu inf in i l i l i Ak u r n Al W a d i a h Mia l u u d a k i 1( ) r|i m ms jan \ a n e be i K> i> i n

1 7 , ) E \ ' I S AKAUN

K O N V F N S I O N A L •

AI W A D I A H

18, Nama Pelaiar (Anak Ahlii

Tuhskan nama anak t u a n / p u a n Mba^annana >ang u n a t a t dalam kail p< ngenalan anak t u a n / p u a n Jikanama mengikut kad p e n g t n a l m lalah Muliamad bin Nounan, sila tuliskan aarna sepeiti di bawah

18 . KAMA I I I AJAK (ANAK AUI I)

M U H A M M A D I 1 \ \ O K M A N

19 Nombor Kad Pengenalan Pelajar

I s i k a n n o m b o r K a d P m f t t i i i l a i i ' d ^ n i n iK t u i n | i\d{]C o n t o h 7 8 1 1 0 5 0"! <>li>f->

1 9 . N O M B O R K A D P E N ( , I \ / \ ) ^ I ' l I V J A R

7 8 1 1 0 5 OS i) 1 b ()

2 0 . Hubungan Ahli Dengan Pelaiar

l a n d a k a n h u b u n g a n a h l i d i n t i n p i i | a i ( a i n k t m m p u a n d i n i a n g a n \ a n g d i s c d i a k a nC o n t o h s e k i r a n v a h u b u n n a n i h l i d< i i " i n p c l a i a i id i l a h i n a k k a n d u n g

2 0 . H U B U N G A \ M i l 1 1)1 \ ( , A N I I I A I \ R

\ N \ K v \ \ \ K ! <K\ W \ K \ \ ( . k \ l

21 . Naima Dan Cawangan Institusi Pengajian Tinggi

Tul iskan n a m a dan cawangan intiiuM pcnj,a]ian tmggiContoh iika n a m a m s t i t u s i pi n»an<ui tmg^i t u a n / p u a n a t a u a n a k t u a n / p u a n m l a h Ui lM S h a h Alamisikan scpert i di bawah

2 1 . NAMA DAN CAWANGAN IKSriTUSI PLNGAJIAN TINGGIU l 1 Ml T s H A II A I A M

22 . Peringkat Pengajian

I n l i s k i n penngka t p t n g a i n n l u u i pu \n u a u anak m a n p u a n nioiigikul kod sepei t i di bawah

2 2 . I F RINGKAI PI NGA.JIAN

I]a/ah 1 Ija/ah I anpii in ; l a m I n n ^ a I t c. S e t i n f 3 Diploma i 4

23. Lokasi Pengaiian

Tuliskan lokasi pengajian tuan/puan atau anak tuan/puan mengikut kod seperti di bawah

Dalam Negara 1 Lur Negara

24. Nama Dan Cawangan Institusi Pemberi Piniaman (Jlka Ada)

Tuliskan nama dan cawangan institusi pemberi pinjaman dengan lengkap

24. NAMA DAN CAWANGAN INSTITUSI PEMBERI PINJAMANM B | F

P E [ T

F

A L

I

I

N

N

A N C

G| | J

E

A

B

Y A

H D |

i

25. Jenis Pengeluaran. Nombor Ahll. Nombor Kad Pengenalan Dan Cap Ibu Jari

Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari klri dan kanantuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.

NAMA

NO. AHLI TEL:(P) (R).

10. PERHATIAN

1 1

12

13

14

15

16

17

Sekiranya permohonan diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannya bagitujuan pengesahan oleh Pegawai KWSP

Sekiranya tuan/puan mengemukakan salinan dokumen sahaja, sila pastikan semua sahnan dokumen telahdisahkan oleh pegawai yang dibenarkan oleh KWSP seperti berikut lengkap dengan nama dan cop rasmipengesah (kecuali salinan dokumen-dokumen tertentu yang telah ditetapkan PegawaiPengesahnya oleh KWSP):-

1 21 Pegawai KWSP yang terdiri danpada 1 2 5- Pegawai KWSP Gred 18 ke atas 1 2 6- Pegawai Kaunter KWSP 1 2 7

1 2 2 Majikan Pemohon 1 2 81 2 3 Penghulu atau Penggawa 1 2 9124 Jaksa Pendamai 1210

Pengamal Perubatan yang berdaftarPenguambeladan PenguamcaraKumpulan Pengurusan/Profesional KerajaanAhli Dewan Undangan NegenAhli ParlimenPesuruhjaya Sumpah

Sekiranya permohonan bersama, sila sediakan 1 set dokumen bagi setiap permohonan

Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam Tuan/puan hendaklahmenurunkan cap ibu jan kin dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Janberwarna hitam

Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-bersama denganpermohonan DIKLIPKAN dan tidak menggunakan dawai kokot (staples)

Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4

KWSP berhak menolak mana-mana permohonan yang tidak lengkap

2.0. DOKUMEN UTAMA

Tandakan (V) dalam kotak yang berkenaan

2 1 PENGELUARAN PENDIDIKAN AHLI

2 1 1 Borang permohonan KWSP 9H (AHL) - 2 salinan

2 1 2 Borang KWSP 3A (AHL) -1 salinan

2 1 3 Salman Kad Pengenalan ahli atau.

Salman Kad Pohs/Tentera dan Surat Pengesahan Majikan menyatakannombor Kad Pengenalan Awam dan Nombor Pohs/Tentera merujuk kepadaorang yang sama,

21 4 Sekiranya pembayaran dibuat kepada ahli, sila kemukakan salinan mukahadapan Buku Akaun Bank yang mempunyai butir-butir akaun tuan/puanatau Penyata Akaun Semasa yang asal Pemohon hendaklah menurunkancap ibu jan km dan kanan di atas salinan tersebut Sekiranya tuan/puanmenghantar melalui pos, salinan dokumen hendaklah disahkan olehPegawai Bank berkenaan dan sek>fanya diserahkan di kaunter silakemukakan dokumen asal beserta salinannya bagi tujuan pengesahanoleh Pegawai Kaunter KWSP

r

•

2.1.5. Surat tawaran kemasukan ke Institusi Pengajian Tmggi (merujuk Tahun 1,2,3dan seterusnya)(Sekiranya salman surat tawaran dikemukakan, hendaklah disahkan oleh PegawaiIPTyang diben kuasa atau Pegawai KWSP seperti di para 1.2.1)

2 1 6. Surat pengesahan yang mengesahkan jumlah yuran pengajian yang dikeluarkanoleh Institusi Pengajian Tmggi yang mengandungi butiran:

(a) Nama dan nombor kad pengenalan ahli(b) Jems kursus di penngkat Diploma ke atas(c) Tahun pengajian

2.2 PENGELUARAN PENDIDIKAN ANAK AHLI

2 2 1 . Borang dan dokumen seperti para 2 1 . 1 - 2 1 4

2.2 2. Salinan Kad Pengenalan Anak Ahli

2.2 3. Salman SIJII Kelahiran AnaK/Sijil Pengesahan Anak Angkat / SIJII Perkahwinan(bukti pertahan bagi anak tin)

2 2 4. Surat tawaran kemasukan ke Institusi Pengajian Tmggi (merujuk Tahun 1, 2,3dan seterusnya)(Sekiranya salinan surat tawaran dikemukakan, hendaklah disahkan oleh PegawaiIPTyang diben kuasa atau Pegawai KWSP seperti di para 121)

2.2.5. Surat pengesahan yang mengesahkan yuran pengajian yang dikeluarkan olehInstitusi Pengajian Tmggi mengandungi butiran • -

(a) Nama dan nombor kad pengenalan anak ahli(b) Jems kursus di penngkat yazah, yazah lanjutan atau yang setaraf dengannya

untuk ahli di Institut Pengajian Tmggi yang berkenaan(c) Tahun pengajian

3.0. DOKUMEN TAMBAH AN

3.1 Pembayaran Kepada Institusi Pengajian Tmggi Dalam Negara

Bagi Permohonan Ahli/Anak Dalam Tahun Pertama

(i) Surat pengesahan pendaftaran danpada Institusi Pengajian Tmggi

a) Nama dan nombor kad pengenalan ahli/anak ahlib) Jems kursus di penngkat Diploma ke atas untuk ahli dan di peringkat ijazah,

ijazah lanjutan atau yang setaraf dengannya untuk anak ahli di InstitusiPengajian Tmggi yang berkenaan

c) Tahun pengajian

3.2 Pembayaran Kepada Ahli Di Mana Ahli/Anak Ahli Mengikuti Pengajian Di Institusi PengajianTmggi Luar Negara

(i) Pasport I I

(n) Visa pelajar (jika berkenaan)

3.3. Pembavaran Balik Kepada Ahli

(i) Resit pembayaran yuran pengajian yang tidak melebihi 1 tahun dan tankhpermohonan.(Sekiranya salinan resit pembayaran dikemukakan, hendaklah disahkan olehPegawai IPTyang diben kuasa atau Pegawai KWSP seperti di para 1 2.1)

23. Lokasi Pengalian

Tullskan lokasi pengajiP.n tuan/puan atau anak tuan/puan mengikut kod seperti dl bawah

Dalam Negara 1 Lur Negara I

24. Nama Dan Cawangan Institusi Pemberi Pinjaman (Jika Ada)

Tuliskan nama dan cawangan tnstltusi pemberi ptnjaman dengan lengkap :

24. NAMA DAN CAWANGAN INSTITUSI PEMBERI PINJAMANM B F F I N A N I C [ E B H D

P E T A L I N G J A Y A ZULU I

25. Jcnis Pengeluaran. Nombor Alili. Norabor Kad Pentfcnalan Pan Cap lbu Jari

Isikan jenis pengeluaran, nombor anil, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanantuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.


HURUFAWALANNAMAAHLI

MOD PEMBAYARAN

WARAN

DRAFBANKASING

ARAHANBAYARAN

KREDITKE AKAUN BANK

1

2

3

4

JENIS AKAUN

KONVENSIONAl

AL WADIAH

1

2

AMAUN OIBAYAR

RINGGIT MALAYSIA

I I I I ISEN

KODPENERIMABAYARAN

AHLI

PUSATPERUBATAN

1

2

DISEMAKOLEHPEGAWAIPENYEMAK

CAW UNIT

I

ITARIKH

NO

IK/TGN

I I

1 NOMBORAHLI

I I I I IT I 13 NOMBORKADPENGENALAN7DIGIT

BUTIRAN A H L I

2 NOMBOR KADPENGENALAN12 DIGIT

I I I I4 NOMBOR POLIS/TENTERA/PASPORT/DSB

I I I I \ IT I I I I I5 KETURUNAN

7 JANTINA

6 NAMAMENGIKUTKAD PENGENALAN/PASPORT

r i i i i 1 I T T I I I 1 IFTTI I M T\ I I I I

LELAKI

PEREMPUAN

I PERBELANJAANPERUBATAN

PERBELANJAAN SEBENAR / ANGGARAN

9 KOS DIBIAYAIOLEH MAJIKAN

RINGGIT MALAYSIA

I I I I ISEN RINGGIT MALAYSIA

I I I ISEN

I10 ORANG MENERIMA RAWATAN

1 AHLI 3ENDIRI

2 SUAMI

3 ISTERI

4 IBU

5 BAPA

6 ANAK

7 ADIK BERADIK

8 ORANG YANG DILULUSKAN

OLEH LEMBAGA

11

TNAM^ ORANG YANG MENERIMA RAWATAN (JIKA BUKAM AHLI SE NDIRI)

I I I T T I II I I I I I I I

12 NO KADPENGENALAN/SIJILKELAHIRANORANC YANG MENERIMA RAWATAN

I I I I I\

13

I II I

I II I

I II

I I I I I I I I I I

ALAMATAHLI

I III

I IM

POSKOD BANDAR

IT IN TNEGFRI

I I I I I I I I I I I

LL I I I I I I i n i i i i

14.

II

NOMBOR TELEFONPEJABAT

T INOMBOR TELEFON RUMAH/BIMBIT

I I I

15 JENIS PEMBAYARAN

WARAN

DRAFBANKASING

ARAHANBAYARAN

KREDITKE AKAUN BANK

BUTIRAN AKAUN BANK (SEKIRANYA PEMBAYARAN DIBUAT KEPADA AHLI)

16 KODBANK 17 NOMBOR AKAUN BANK

JLU I I I I I ITTT l i n I TTI I I18 JENIS AKAUN

KONVENSIONAL

AL WADIAH

NOMBORAHU E NOKAOPENGENALAN

F T I I I I J U T I I J.JEMSPENCELUARAN

BUTIR-BUTIR PESAKIT

1 NAMA SUAMI / ISTERI YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA SILA NYATAKAN NAMA PENUH, NO KAD PENGENALAN DAN UMUR

(POTONG Dl MANA TIDAK BERKENAAN)

NAMA MENGIKUT KAD PENGENALAN NO KAD PENGENALAN UMUR

in)

IV)

2 NAMA ANAK-ANAK YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA, SILA NYATAKAN NAMA PENUH, JANTINA, NO KAD PENGENALAN DAN

UMUR

NAMA MENGIKUT KAD PENGENALAN JANTINA NO KAD PENGENALAN UMUR

in)

3 NAMA IBU / BAPA YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA, SILA NYATAKAN NAMA PENUH, JANTINA, NO KAD PENGENALAN DAN

UMUR


4 NAMA ADIK-BERADIK YANG BERUMUR 16 TAHUN KEATAS YANG SAH DARI SEGI UNDANG-UNDANG JIKA ADA SILA NYATAKAN NAMA PENUH,

JANTINA, NO KAD PENGENALAN DAN UMUR


i)

II)

IV)

PEMBERITAHUANDISAHKANOLEH:

PEGAWAIPENGESAH

NO K/TGN

Mil l

TARIKH

DILULUSKANOLEH:PEGAWAIPELULUS1

NO K/TGN

1ARIKH

PEGAWAIPELULUS2

NO K/TGN

I I I I I

TARIKH

BUTIRAN HOSPITAL / INSTITUSI PERUBATAN / KESIHATAN

19.

i I I I INAMA HOSPITAL / INSTITUSI PERUBATAN / KESIHATAN

I I I I I I IMi l l I I I I I I I I

I I II I I

20. ALAMAT HOSPITAL /INSTITUSI PEflUBATAN / KESIHATAN

II

I I I I I I II I I I I I I

I I IM M

II I I I I III II I I I II

POSKOD BANDAR

i i i i i iNEGERI

LL 1 1 1 I I I I I I T I I T I T I I I

1. SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTAKWSP 1991.

2 SAYA BERSETUJU SUPAYA JUMLAH KREDIT YANG DIKELUARKAN DARI AKAUN SAYA DIBAYAR TERUS KEPADAHOSPITAL/INSTITUSI PERUBATAN/KESIHATAN MENGIKUT JUMLAH DALAM BIL YANG OIPERSETUJUI OLEH SAYA(JIKA AHLI MENGGUNAKAN SURAT JAMINAN KWSP UNTUK MENERIMA RAWATAN)

21.

JENIS PENGELUARAN

NOMBOR AHLI

CAP IBU JARI KIRI

DAN KANAN AHLI

(MESTI DITURUNKAN

DENGAN TERANG

DAN PENUH

MENGGUNAKAN

PAD CAP IBU JARI

BERWARNA HITAM)

TARIKH-

H NOMBOR

KIRI KANAN

PANDUAN UNTUK MENGISI BORANG KWSP 9D (AHL)PEMBERITAHUAN PENGELUARAN KESIHATAN

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAHDIPENUHIDENGAN HURUF BESAR.

1. Nombor Ahll

Isikan satu digit di setiap ruang dengan didahului oleh digit '0' jiKa perlu, seperti contoh di bawah

Contoh : 1234567

1. NOMBOR AHLI

4.

5 .

0 1

Nombot Kad Pengenalan 12 Digit

Isikan nombor Kad Pengenalan 12 digit tuan/puan. Jika tuan/puan belum memilikl Kad Pengenalan12 digit, kosongkan ruangan ini :

Contoh : 610701-02-6157


o 0 1 0 1

Nombor Kad Pengenalan 7 Digit

Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah :


a)

b)

c)

d)

1234567

A 1234567

K 1234567

H 1234567

Nombor Polls/Tentera/Pasport/Dsb

Isikan Nombor Kad Pengenalan Polls/Tentera/Pasport/Dsb termasuk huruf awalan, seperti contoh di bawah

4. NOMBOR POLIS/TENTERA/PASPORT/DSB2

2

3

3

4 5

" 4~1 5 "

6

6

7

7

a) I 1234567

b) T 1234567

Ketnrunan

Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, isikanseperti di bawah :

5. KETURUNAN [ 1


1234

BidayuhKadazanIban

567

6. Nama Mengikut Kad Pengenalan/Pasport

Tuliskan nama tuan/puan sebagaimana yang tercatat delam kad pengenalan tuan/puan. Jlka nama mengikutkad pengenalan ialah Norman bin Abdullah, sila tuliskan nama seperti di bawah :

N O R M

6. _NAMA MENGIKUT KAD PENGENALAN/PASPORT

^ N rB I I N A B D U ! L

1JLH

7. Jantina

Tandakan jantina tuan/puan dengan K) dalam ruang yang disediakan Jika lelaki, tandakan K) di ruangyang berkenaan seperti di bawah

7. JANTINA

LELAKI

PEREMPUAN

Perbelanjaan Perubatan

Sebenar/anggaran ialah bil perubatan yang telah atau akan dikenakan oleh pusat rawatan yang diktiraf.Kos rawatan akan dikenakan oleh pusat rawatan yang diiktiraf. Jika kos rawatan yang dikenakan untukpenyakit kanser ialah RM 10.000 00, isikan seperti di bawah

8. PERBELANJAAN PERUBATAN

SENRINGGIT MALAYSIA

0 0 1 0 0 0 0 0 0

9. Kos Yang Dibiavai Oleh Maiikan

Kos rawatan yang dibiayai oleh majikan. ContohnyaKos rawatan pesakit (isteri) RM 10,000.00Biayai majikan: RM 4,000.00Isikan seperti berikut .

9. KOS YANG DIBIAYAI OLEH MAJIKAN

RINGGIT MALAYSIA

0 0 0 4 0 0 0

SEN

0 0

10. Orang Yang Menerima Rawatan

Tandakan hubungan pesakit dengan pemohon di ruangan berkenaan •

Contoh: Pesakit ibu, tandakan ( ^ )

10. ORANG YANG MENERIMA RAWATAN

1. AHLI SENDIRI

2. SUAMI

3. ISTERI

4 IBU

5 BAPA

6. ANAK

7. ADIK-BERADIK

8. ORANG YANG DILULUSKAN

OLEH LEMBAGA

Nama Orang Menerima Rawatan (Jika bukaa ahli sendiri)

Jika orang yang menerima rawatan adalah ibu tuan/puan, isikan nama ibu tuan/puan di dalam petak-petakyang berkenaan. Jika nama ibu tuan/puan adalah Julia bte Ahmad, tuliskan seperti di bawah :

J

11

u. NAMA

L I

ORANG

A

MENERIMA

B T E

RAWATAN (JIKA

A H M

BUKAN

A D

\HL1 SENDIRI)

12. No. Kad Pengenalan/ Sijlll Kelahiran Orang vang Menerima Rawatan

Islkan No. Kad Pengenalan orang yang menerlma rawatan. Contohnya, jlka No. Kad Pengenalan ibu tuan/puan ialah 450903 - 01 - 2346, tullskan sepertl dl bawah :

12. NO. KAD PENGENALAN/ SIJIL KELAHIRAN ORANG YANG MENERIMA RAWATAN

0 0

13. Alamat Ahli

Tullskan alamat surat menyurat tuan/puan dengan lengkap. Jlka alamat surat menyurat tuan/puan adalahLot 10, Kg Pant Kadlr Tlmur, Buklt Paslr, 84300 Muar, Johor Darul Takzlm, slla penuhl sepertl berlkut •

T

O

I

T

M

POSKOD

8 4 3

NEGER1

J O H

U

0

o

1

R

0

0

R

B

K

U

G

K

BANDAR

M U A

D A. 1 R

I

R

U

13.

P

T

L

ALAMAT AHLI

A R

P

T

I

A

A

T

S

K

I

Z

R

I

A D I R

M

14. Nombor Telefon

Islkan nombor telefon dl ruangan yang dlsedlakan dl bawah :

Contoh : Nombor Telefon Pejabat : 07 - 9859450 dan Nombor Telefon Rumah/Blmbit : 016 - 2070158

14. NOMBOR TELEFON PEJABAT8 0

NOMBOR TELEFON RUMAH/BIMBIT

2 0 7 10 1 5 8

IS. Jenis Pembavaran

Jika t uan /puan memilih kaedah pembayaran kredit ke akaun bank, tanda K ) dl ruang yang berkenaansepertl dl bawah ;

WARAN

DRAF BANK ASING

I S . JENIS PEMBAYARAN

ARAHAN BAYARAN

KREDIT KE AKAUN BANK 1'16. Kod Bank

Isikan nombor kod bank dl ruangan yang disediakan seperti di bawahJlka kod bank tuan/puan adalah Maybank

16. KOD BANK

RHB BankMaybankBumiputra CommercePublic BankHong Leong BankHong Leong FinanceAffin BankEON Bank

010 20 30 40 50 6070 8

Arab Malaysian BankAlliance BankSouthern BankUtama BankBank MuamalatArab Malaysian FinanceBank Islam

0 91011120 31314

17, Nombor Akaun Bank

Jika nombor akaun bank adalah 1-23456 -789012-3, islkan ruangan berkenaan sepertt di bawah :


1 3 I 9 | 0 1

18. Jenip Akaun

Jika akaun tuan/puan adalali jenis konvensional, tanda ( /) di ruang yang berkenaan sepcrti di bawah

18. JENIS AKAUN

KONVENSIONAL

AL-WADIAH

19. Nama Hospital/Institusi Perubatan/Kesihatan

Jika tuan/puan/pesakit mendapat rawatan daripada Pusat Pakar Utara Sdn. Bhd., sila tuliskan seperti dibawah :

p

s

u

D

19. NAMA HOSPITAL

S

N

A T

B H

P

D

A

INSTITUSI

K A 1 RPERUBATAN/KESIHATAN

U T A R A 1

20. Alamat Hospital/Institusi Perubatan/Kesihatan

Jika alamat hospital berkenaan adalah No. 21, Jalan 11/2, 40000 Shah Alam, Selangor Darul Ehsan,Tuliskan seperti di bawah :

20. ALAMAT HOSPITAL/INSTITUSI PERUBATAN/KESIHATAN

N 0

POSKOD

4 0 0

2

0

1

0

J A L

• BANDAR

S H A

A

H

N

A

1

L

1

A

/ 2

M

NEGERI

S E L A N G O R D A R U L E H S A N

21 . Jenis Pengeluaran. Nombor Ahli. Npmbor Kad Pengenalan Dan Cap Ibu Jar!

Isikan jenis pengeluaran, nombor ahli, nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanantuan/puan dengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hltam.

NAMA :

NO. AHLI : TEL:(P) (R).

1.0 PERHATIAN

1.1

1.2

1.3

1.4

1.5

1.6

1.7

Sekiranya permohonan diserahkan di kaunter KWSP, sila kemukakan dokumen asal beserta salinannyauntuktujuan pengesahan oleh Pegawai KWSP.

Sekiranya tuan/puan mengemukakan salinan dokumen sahaja, sila pastikan semua salinan dokumen telahdisahkan oleh pegawai yang dibenarkan oleh KWSP seperti berikut lengkap dengan nama dan cop rasmipengesah (kecuali salinan dokumen-dokumen tertentu yang telah ditetapkan PegawaiPengesahnya oleh KWSP):

1.2.1. Pegawai KWSP yang terdiri daripada- Pegawai KWSP Gred 18 keatas- Pegawai Kaunter KWSP

1.2.2. Majikan Pemohon1.2.3. Penghulu atau Penggawa1.2.4. JaksaPendamai

1.2.5. Pengamal Perubatan yang berdaftar1.2.6. Peguambela dan Peguamcara1.2.7. Kumpulan Pengurusan/Profesional Kerajaan1.2.8. Ahh Dewan Undangan Negeri1.2.9. Ahli Parlimen

1.2.10. Pesuruhjaya Sumpah

Sekiranya permohonan bersama, sila sediakan I set dokumen bagi setiap permohonan.

Setiap borang permohonan hendaKlah ditulis dengan pena dakwat berwarna hitam. Tuan/puan hendaklahmenurunkan cap ibu jari kiri dan kanan dengan terang dan penuh menggunakan Pad Cap Ibu Jariberwama hitam.

Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-sama dengan borangpermohanan DIKLIPKAN dan tidak menggunakan dawai kokot (staples).

Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4.

KWSP berhak menolak mana-mana permohonan yang tidak lengkap.

2.0 DOKUMEN UTAMA

Tandakan ( V ) dalam kotak yang berkenaan

2.1 Borang Permohonan KWSP 9D (AHL) - 2 salinan | |

2.2 Borang KWSP 3A (AHL) -1 salinan [

2.3 Salinan Kad Pengenalan ahli, ateu I I

Salinan Kad Pengenalan Poiis/Tentera dan Surat Pengesahan Majikan menyatakan | |Nombor Kad Pengenalan Awam dan nombor Polis/Tentera merujuk kepada orangyang sama.

2.4 Salinan muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan slauPenyata Akaun Bank Semasa yang asa! Pemohon hendaklah menurunkan cap ibu jari kiri dankanan di atas salinan tersebut. Sekiranya tuan/puan manghantar melalui pos, salinan dokumenhendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, silakemukakan dokumen asal beserta salinannya bagi tujuan pengesahan oleh Pegawai KaunterKWSP.

2.5 Laporan Perubatan yang tidak melebihi satu tahun yang mengandungi: | [

(a) Butiran Pesakit(b) Keadaan Kesihatan semasa Pesakit(c) Tankh Laporan(d) Nama Pusat Perubatan(e) Nama dan Cop Rasmi Doktor(f) Tandatangan Doktor

(Sekiranya salinan Laporan Perubatan dikemukakan, hendaklah disahkan oleh Doktor/Hospitalberkenaan atau Pegawai KWSP seperti di para 121)

2.6 Surat pengesahan dan maiikan samada kos rawatan dibiayai oleh majikan atau tidak [__

(Sekiranya pesakit adalah anak pengesahan majikan ibu dan bapa diperlukan dan sekiranyapesakit bekerja, surat pengesahan majikan pesakit juga diperlukan Bagi pesakit Dasangan suamiisten, pengesahan majikan pesakit dan pasangan diperlukan)

2 7 Bil dan resit bayaran dan pusat perubatan yang tidak melebihi satu tahun dan tankh permohonan | |(jika bayaran telah dibuat)

ATAU

Anggaran kos rawatan dan pusat perubatan atau pakar bagi rawatan yang dilakukan bagi ahliyang memerlukan surat jaminan KWSP untuk mendapatkan rawatan

(Sekiranya salinan bil/resit bayaran/anggaran kos rawatan dikemukakan, hendaklah disahkanoleh Doktor/Hospital berkenaan atau Pegawai KWSP seperti di para 1.2.1)

2.8 Bukti pertahan di antara ahli dan pesakit. (Jika pemohon bukan pesakit)

Tandatangan Ahli : Tankh

Tandatangan Penenma : Tankh

KUMPULAN WANG SIMPANAN PEKERJA1 OGOS 2001

KWSP9C (AML)PERCUMA

AKTA KUMPULAN WANG SIMPANAN PEKERJA1991PEMBERITAHUAN PENGELUARAN

MEMSEU / MEMBINA RUMAH ATAU MENGURANGKAN / MENYELESAIKAN PINJAMAN

PERHATIAN • MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATA'J TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEMBERIKAN APA-APADOKUMEN PALSU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MELAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BOLEH DIDENDA ATAU DIPENJARA ATAUKEDUA-DUANYA


KP

HURUF AWALANNAMA AHLI

MOD PEMBAYARAN

WARAN

DRAF BANK ASING

ARAHAN BAYARAN

KREDITKEAKAUNBANK

1

2

3

4

KOD PINJAMAN

AHLI

PASANGAN

JENIS AKAUN

KONVENSIONAL

ALWADIAH

1

2

DISEMAKOLEHPEGAWAI PENYEMAK

CAW UNfT

NOK/TGN

TARIKH

1 JENIS PFNGELUARAN YANG DIPOHON SILA TANDAKAN I -J) PI KOTAK YANG BERKENAAN

1 JENIS PENGaUARAN

1

2

3

MEMBai / MEMBINA RUMAH

MENGURANGKAN / MENYaESAIKAN PINJAMAN

MENGURANGKAN / MENYaESAIKAN PINJAMAN PASANGAN

PERTAMA KEDUA

2 NOMBORAHLI

BUTIRANAHU


4 NO KAD PENGENALAN 70IGIT/POUS/TENTERA/PASPORT/DSB 5 TARIKH SURATPERJANJIAN JUAL BELI 6 KETURUNAN

•7 NAMA MENGIKUT KAD PENGENALAN/PASPORT

1

1

JANTINA

1ELAKI

PEREMPUAN

9 HARGA BaiAN / KOS PEMBINAAN 10 JUMAH PINJAMAN / BAKI PINJAMAN

RINGGIT MALAYSIA SEN RINGGIT MALAYSIA SEN

11 SEKTOR PEKERJAAN 12 BUTIRANHARTA

BEKERJASENDIRI

KERAJAAN

SWASTA

TIDAK BEKERJA

NO LOT/PT

NO HS(M/D)

NO PARCEL

FLAT/APP/

KONDOMINIUM

13 ALAMAT HARTA

|

POSKOO BANDAR

NEGERI

14 ALAMAT AHLI

I T I I IPOSKOD BANDAf

NEGERI

15 NOMBOR TaEFON (PEJABAT)

NOMBOR TaEFON (RUMAH)i

16 JENIS PEMBAYARAN

WARAN

DRAF BANK ASING

ARAHAN BAYARAN

KREDITKEAKAUNBANK

17 KOD BANK

BUTIRAN BANK

18 NOMBOR AKAUN BANK (Hanya untuk membei/membma mmah)

19 JENIS AKAUN

KONVENSIONAL

AL-WADIAH

| I I20 NOMBOR AKAUN PINJAMAN PERUMAHAN

(Hanya untuk mengurang/menyetesakan pin|amanj

| I I

AKTA KUMPULAN WANG SIMPANAN PEKERJA 1991PEMBERITAHUAN PENGELUARAN

50 TAHUN/55 TAHUN/DIVIDEN/KETIDAKUPAYAAN

KWSP98(AHL)PERCUMA

PERHATIAN MANAMAM ORAN& YANG MEMBUAT W APA KENYA MAN U N G TIDAK BETUL \TAU TIDAK BENAP A I A U M NGFMUKAKAN ATAU MEMBERiKAN APAAPA DOKUVLN PAISLJALAM A H A / O A BUTIRBUTIR MUSTAhAK ADALAH MELAKJKAN KfcSALAHAN DAN AKAN MENYE8ABKAN ) RlNYA BOLEH DIDENDA ATAU DIPENJARA ATAU KEDUA DUANYA


KP

l

KJRLFAWALAN\|AKA AHL

•L"X_"MOD PFMBAYARAN

/VARAN

DRAFBANKASING

\RAHAN BAYARAN

KREDIT KEAKAl IN BANK

__JENISAKAUN

KONVENSIONAL

Al WADIAH

STATUS AKAJNAHU

I Pt.NE.RiVK BAY/"ANt. _ —

AHL!

UISEMAK OLEHPFGAWAI PFNYFMAK

1 AW |

I r\—

NIT

NO KTCN

JZLT:1 \RIKH

DISAHKANOLEHPLGAWAI PENGESAH

NO KTGN

~T~TL_ I

ARKH

DILULoSKAN OLtHPECAWM PELJLUS 1

NO

J.

ARKH

PEGAWAI PELULUS 2

NO K/TGN

L. TARIKH

SILATANOAKAN (V) Dl KOTAKYANGBERKbNAAN

1 JENIS

PtNGELLARAN

50 TAHUN

DI/IDEN

ri5 TAHUN

KE [IDAKUPAYAAN

LNTUK PENGELUARAN 55TAHUNFKIRANYA AHLI MASIH BEKERJA DAN NGIN IfcRUS

\FNCARUM TANDAKAN (V) Dl RUANGAN BERKENAAN1 NblN TERUS MENCARUM YA ( ) "IDAK ( ) JIKA M

bILA ISIKAN BORANG KWSP 20 (AHL) DAN KWSP ?0A AriL)' i iiiTiii/ nc r̂rtCi I IADIU DCUIIU

BUTIRANAHIl

2 NOMBOR AHII

UNTUK PENGELUARAN PENUHADA PEMINDAHAN PELABURAN YA (

1 I OMBOR KAD PENGENALAN 12 DIGIT

TIDAK (

4 NOMBOR KAD PENC EN \LAN 7 DIGIT 5 NOMBfR POMS TENTERA/PASPORT/DSB

nrrnmnzz

6 NAMA MENGIKUT KAD PENGENALAN/PASPARr

nnznznn: nxizn 7 KETURUNAN

_ L Ih

8 TARIKH LAHIR

h B B T T

9 JANTINA

TJ L

10 SEKTOR PEKERJAAN

LEuAKI

PEREMPUAN

11 ALAMATAHU

PJ&KOD

NEGfcRI

BANDAR

12 NOMBOR TELEFON PEJABAT

inu i in iTxrn:13 JENIS PEMBAYARAN

WARAN

NOMBOR TbLEFON RUMAH/BIMBIT

njznjrrN

BANK \SING

ARAHAN BAYARAN

KREDIT KEAKAUN BANK

BUTIRAN AKAUN BANK

14 KOOBANK 11) NC MBOR AKAUN BANK nn16 JENIS_AKAUN

KONVENSIONAL

nL WAOIAt ISAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Di KWSP MENURUT PERUNTUKAN AKTA KWSP 1991

17

JENIS PENIGtLUARAN

NOMBOKAHU1

CAP Bt i R K R ( ANKANANAHLI

(MESTI DITJKUNKAN DtNOANTrRAMGDANPENJH

CAMBUJARIBf-RW RNAH AM)

NOVRO'< Wf

K1SJj '

1ARIKI-

T ""I

LJMNAH

KUMPULAN WANG SIMPANAN PEKERJA

SENARAISEMAKAN SKIM PENGELUARAN PERSARAAN50 TAHUN/55 TAHUN/DIVIDEN

NAMA : ,.

NO.AHL! : , TEL: (P) , (R)

1.0 PERHATIAN

1.1. Sekiranya permohonan diserahkan di kaunter, sila kemukakan dokumen asal beserta salinannyabagi tujuan pengesahan oleh Pegawai KWSP.

1.2. Sekiranya tuan/puan mengemukakan salinan dckumen sahaja, sila pastikan semua salinan telahdisahkan oleh pegawai yang dibenarkan oleh KWSP seperti bcrikut lengkap dengan nama dan coprasmi pengesah : -

1.2.1. Pegawai KWSP yang terdiri daripada 1.2.6. Peguambela dan Peguamcara- Pegawai KWSP Gred 18 keatas 1.2.7. Kumpulan Pengurusan/Profesional

Pegawai Kaunter KWSP Kerajaan1.2.2 Majikan Pemohon 1.2.8. Ahli Dewan Undangan Negeri1.2.3 Penghulu atau Penggawa 1.2.9. Ahli Parlimen1.2.4 Jaksa Pendamai 1.2.10. Pesuruhjaya Sumpah1.2.5 Pengamal Perubatan yang berdaftar

1.3. Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwarna hitam. Tuan/puanhendaklah menurunkan cap ibu jari kin dar kanan dengan terang dan penuh menggunakan PadCap ibu Jari berwarna hitam.

1.4. Tuan/puan hendaklah memastikan dokumen-dokumen yang disertakan bersama-sama denganborang permohonan DIKUPKAN dan tidak menggunakan dawai kokot (staples).

1.5. Semua salinan fotostat dokumen hendaklah menggunakan kertas saiz A4.

1.6. KWSP berhak menolak mana-mana permohonan yang tidak lengkap.

2.0 DOKUMEN UTAMA

Tandakan (V) dalam kotak yang berkenaan.

2.1. Borang permohonan KWSP 9B(AHL) - 2 salinan

2.2. Borang KWSP 3A (AHL) - 1 salinan

2.3. Salinan Kad Pengenalan

Salinan Kad Pengenalan Polis/Tentera danSurat Pengesahan Majikan menyatakan No. Polis/Tentera danNo. Kad Pengenalan merujuk kepada orang yang sama

2 4 Salinan pasport bagi warganegara aslng(Sila kemukakan salinan pasport yang lama sekiranya nombor pasport terkiniberbeza dengan rekod KWSP)

2 5 Salinan muka hadapan Buku Akaun Bank yang mengandungi butir-butir akauntuan/puan atau Penyata Akaun Bank Semasa yang asal. Pemohon hendaklahmenurunkan cap ibu jari kin dan kanan di atas salinan tersebut. Sekiranya tuan/puanmenghantar melalui pos, salinan dokumen hendaklah disahkan oleh Pegawai Bankberkenaan dan sekiranya diserahkan di kaunter, sila kemukakan dokumen asal besertasalinannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSP

3.0 DQKUMEN TAMBAHAN

3 1 Sijil Kerakyatan/Syil Kelahiran (jika No Kad Pengenalan tiada dalam rekod KWSP)

Tandatangan Ahli Tarikh

Tandatangan Penerima : Tarikh

KUMPULAN WANG SIMPANAN PEKER.JA1 OGOS 2001


50 TAHUN/55 TAHUN/DIVIDEN/KETIDAKUPAYAAN

KWSP 9B (AHL)PERCUMA

PERHATIAN : MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK BETUL ATAU TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEMBERIKAN APA-APA DOKUMEN PAl.SUDALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MF.LAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BO1.EH DIDENDA ATAU DIPENJARA ATAU KEDUA-DUANYA


i KREDIT KE AKAUN BANK

JENISAKAUN

KONVENSIONAL

AL-WADIAH

1

2

STATUS AKAUN AHLI

AKTIF

TUTUP

(UNTUK PENGELUARAN D2-5)

PENERIMA BAYARAN

AHLI

PENJAGA

(UNTUK PENGELUARAN D2-6)

OISEHAKOLEH :Pf.GAWAIPENYEMAK

SILATANDAKAN (V) Dl KOTAK YANG BERKENAAN

1. JEMS

PENGELUARAN

1

3

50 TAHUN

DIVIDEN

2 | 55TAHUN

4 I KETIDAKUPAYAAN I

BUTIRAN AHLI

UNTUKPENGELUARAN55TAHUN: jSEKIRANYA AHLI MASIH BEKERJA DAN INGIN TERUS |MENCARUM, TANDAKAN (V) Dl RUANGAN BERKENAANINGIN TERUS MENCARUM YA ( ) TIDAK { j . JIKAYA,SILA ISiKAN BORANG KWSP 20 {AHL) DAN KWSP 20A [AHL) iUNTUK PENGELUARAN PENUH : |ADAPEMINDAHAN PELABURAN. YA( } TIDAK', ) I

2. NOMBOR AHLI

J4. NOMBOR KAD PENGENALAN 7 DIGIT

_ _ I

L J L3. NOMBOR KAD PENGENALAN 12 DIGIT

r r r EEUD5. NOMBOR POUS/TENTERA/PASPORT/DSB

6. NAMA MENGIKUT KAD PENGENALAN/PASPORT

imnmu-immrnmcmnmujjjjjjjmnmni]

8. TARIKri LAHIR 9. JANTINA 10. SEKTOR PEKERJAAN

7. KETURUNAN

•H H B 8 T T LELAKI

PEREMPUAN

•mm:11. ALAMATAHLI

BEKERJA SENDIRI

KERAJAAN

SWASTA

TIDAK BEKERJA

rm ~ Tmir rHi.. TUT i—|—

CAW UNIT

NO. K/TGN

IIL:TARIKH :...

OISAHKANOLEH :PEGAWAIPENGESAH

POSKOD

•mrNEGERI

n

BANDAR

in

12. NOMBOR TELEFON PEJABAT

D"713. JENIS PEMBAYARAN

NOMBOR FELEFON RUMAH/BIMBIT

I Z L T T T E E I T T ]

WARAN

ORAF BANK ASING

ARAHAN BAYARAN

KREDIT KE AKAUN BANK

BUTIRAN AKAUN BANK

TARIKH

DILULUSKAN OLEH :PEGAWAI PELULUS1

TARIKH

PEGAWAI PELULUS 2

I NO. K/TGN !

LIITTIIIJTARIKH :

14. KOD BANK16. JENISAKAUN

•i5. NOMBOR AKAUN BANK

XD nmmm KONVENSIONAL

AL-WADIAH

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991.17.

JENIS PENGELUARAN

NOMBOR AHLI

CAP IBU JARI KIRI DANKANAN AHLI

(MESTI DITURUNKAN DENGANTERANG DAN PENUHMENGGUNAKANPAD

CAP IBU JARI BERWARNAHITAM)

TARIKH :

NOMBOR K/P nKIRI KANAN

PANDUAN UNTUK MENGIS! BORANG KWSP 9B (AHL)

PEMBERITAHUAN PENGELUARAN 50 TAHUN / 55 TAHUN / DIVIDEN / KETIDAKUPAYAAN

SILA BACA PANDUAN INI DENGAN TELITI SFBELUM MENGISI BORANG. BORANG PERMQHQNAN MESTILAH DIPENUHKAN DENGAN HURUFBESAR.

1. Jenis Pengeluaran

Siia tanda (V) dalam petak yang berkenaan Jika tuan/puan memohon pengeluaran 50 Tahun, tandakan (V) seperti di bawah •

. 1. JENISPENGELUARAN

i_3_±

50 TAHUN

DIVIDEN

55 TAHUN

KETIDAKUPAYAAN

Untuk Pengeluaran 55 Tahun

Sekiranya ahli masih bekerja dan mgin terus mencaoim, sila tandakan (V) di ruangan yang berkenaan.

INGIN TERUS MENCARUM ( V) YA ( ) TIDAK

Untuk Pengeluaran Penuh

ADA PEMlNDAHAN PELABURAN, YA ( V ) TIDAK ( )

Nombpr Ahli

Isikan satu digit di setiao ruang dengan didahului oleh digit '0' jika perlu, seperti contoh di bawah:

Contoh : 1234567

2. NOMBORAHLI

0 1 2

3. Nombor Kad Pengenalan 12 Digit Ahli

Isikan nombor Kad Pengenalan 12 digit tuan/puan Jika tuan/puan belum memiliki Kad Pengenalan 12 digit, kosongkan ruanganini :

Contoh : 460701-02-6157


I0 1 0 JNombor Kad Pengenalan 7 Digit

Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawah


a)

b)

1234567

A 1234567

2

L73

» .LL 5 g—̂

7

c) K1234567

d) H1234567 6

5. Nombor Polis/Tentera/Pasport/Dsb

Isikan Nombor Polis/Tentera/Pasport/Dsb, seperti contoh di bawah :

5. NOMLOR POLISffENTERA/PASPORT/DSB

a) I 1234567 ' 1

b) T 1234567 1 2 3 5

Nama Mengikut Kad Pengenalan/Pasport

Tuliskan nama tuan/puan sebagaimana yang tercatat dalam kad pengenalan. Jika nama mengikut kad pengenalan ialah Norman

bin Abdullah, sila tuliskan nama seperti di bawah;

N 0 R6.M

NAMA MENGIKUT KAD PENGENALAN/PASPORT

A N B JJ N

i

A B D U L L A H

Keturunan

Isikan ruang dengan mengikut kod keturunan di bawah ini. Jika tuan/puan berketurunan Melayu, isikan seperti di bawah:

7. KETURUNAN


1

1234

BidayuhKadazanIban

Tarikh Lahir

Isikan tarikh lahir tuan/puan mengikut susunan hari, bulan dan tahun. Jika tarikh lahii tuan/puan pada 1 Julai 1946, isikan seperti dibawah:

8. TARIKH LAHIR

H

0

H

1

B

0

B

7

T

4

T

6

Jantina

Tandakan jantina tuan/puan dengan (S) dalam ruang yang disediakan. Jika lelaki, tandakan (V) di ruang yang berkenaan sepertidi bawah:

9. JANTINA

LELAKI

PEREMPUAN

10. Sektor Pekeriaan

Tandakan (</) dalam ruang yang disediakan. Jika tuan/puan bekerja dalam sektor swasta, tanda (S) dalam ruang yang berkenaan

seperti di bawah:

10. SEKTOR PEKERJAAN

BEKERJA SENDIRI

KERAJAAN

SWASTA

TIDAK BEKERJA

11. Alamat AhliTuliskan alamat surat menyurat tuan/puan dengan lengkap. Jika alamat surat menyurat tuan/puan adalah Lot 10, Kg Parrt KadirTimur Bukit Pasir, 84300 Muar, Johor Darul Takzim, sila penuhi seperti berikut:

12.

13.

L

| T

O T

I

POSKOD

I ' 4

NEGERI

I ' 0

M

3

H

Nombor Telefon

1 "of TKI I

G

U

0

O

R I ] B I U

BANDAR

0

R

K

A

R

1

R

U

11. ALAMAT AHLI

A R

P

T

I

A

A

1

s 1

K 1

K

»

A D 1 R

1

M

Isikan nombor telefon di ruangan yang disediakan di bawah.

Contoh : Nombor Telefon Pejabat: 07-9859450 dan Nombor Telefon Rumah/Bi.-nbit 016-2070158

12. NOMBOR TELEFON PEJABAT

7 9 8 sT7T4 5•

NOMBOR TtLEFON RUMAH/BiWBIT

lil 1 6

Jenis Pembavaran

?J 0 |7 [0 1 5 | .

Jika tuan/puan memilih cara pembayaran kredit ke akaun bank, tanda (S) di ruang yang berkenaan seperti di bawah .

13. JENIS PEMBAYARAN

WARAN

DRAFBANKASINGi LARAHAN BAYARAN

I KREDIT KE AKAUN BANK

14. KodJank

isikan nombor kod bank di ruangan yang disediakan seperti di bawahJika kod bank tuan/puan adalah Maybank

14. KOD BANK

rzRHB BankMaybankBumiputra CommercePublic BankHong Leong BankHong Leong FinanceAffin BankEON Bank

0102030405060708

Arab Malaysian BankAlliance BankSouthern BankUtama BankBank MuamalatArab Malaysian FinanceBank Islam

09101112131415

15. Nombor Akaun Bank

Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah


1 2 3 4 5 6 7 8 9 0 1 2 3

16. Jenis Akaqn

Jika akaun tuan/puan adalah jenis konvpnsional, tanda (*Q di ruang yang berkenaan seperti di bawah

16. JENIS AKAUNKONVENSIONAL

AL-WADIAH

•

17. Jenis Pengeluaran, Nombor Ahli. Nombor Kad Pengenalan dan Cap Ibu Jari

Isikan jenis pengeluaran, nombor ahl' dan nombor kad pengenalan serta turunkan cap ibu jari kin dan kanan tuan/puandengan terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam

KUMPULAN WANG SIMPANAN PEKERJAEMPLOYEES PROVIDENT FUND

SENARAI SEMAKAN SKIM PENGELUARAN MENINGGALKAN NEGARALEAVING COUNTRY WITHDRAWAL CHECKLIST

Nama AhliMember's Name

No Ahli Tel (P) (R)Member's No Tel(O) (R)

No PasportPassport No

10 PENTINGIMPORTANT

1 1 Sekiranya permohonan diserahkan di kaunter KWSP sila kemukakan clokumen asal beserta salmannya untuk

tujuan pengesahan oleh Pegawai KWSPWhen submitting the application form at the counter please produce ongmal documen's together with the photostate copies of the documentfor the purpose of certification by EPF officers

" ? bekiranya tuan/puan mengemukakan salinan dokumen sahaja sila pastikan semua saiman dokumen telah disahkan oiehmajikan tuan/puan dtau pegawai yang dibenarkan oleh KWSP seperti benkul lengkap dengan nama da i cop rasmipengesah -When submitting photostate documents please ensure that photostate copies of all the documents are certified true copy by vcur e 7)o/o> er orauthorized officers as follows complete with the name and official stamp of the officer concerned

1 21 Pegawai KWSP -EPF Officer

Pegawai KWSP (Gred 18 ke ata«)EPF Officer (Grade 18 and Above) '

Pegawai Kaunter KWSPEPF Counter Officer

1 2 2 Pegawai Kedutaan MalaysiaMalaysian Embassy Officer

' 2 3 Notan AwamPublic Notary

1 3 Setiap borang permohonan hendaklah ditulis dengan pena dakwat berwdrna hjldDl Tuan/puan hendaklah menurunkan capbu jan kin dan xanan de^iqan terang dan penuh menggunakan Pad Cap Ibu Jan bciyvarna hjtam.Ldch withdrawal form must be completed using bjsoi ink pa Members must a/so affix higher nght and left thumbpnnt cleiriy and in lullusing black ink thumbpnnt psd

14 Tuan/puan henolakldh rr^mastikdn dokumen dokunen yang disertakan beibama sama dengan borang oermohonanDIKLIPKAN dan tidak menggunakan dawai kokot (staples)Please ensure that all documents forwarded togethei with the apulicatior form are CLIPPER md not stappled

1 5 Semua salinan fotostat dokumen hendaklah me iggunakin kertas saiz A4All photostate cop'es of documents must be on A4 sue pap°r

1 6 KWSP berhak menolak mana manu permohoPcn yang •idak lengkapEPF reserves the ngh1 to 'eject incomplete application

2 0 DOKUMEN UTAMA

MAIN DOCUMENTS

Tandakan (V) dalam kotak yang berkenaanPlease tick (V) in the box where applicable

2 1 Borang Permohonan KWSP 9B (AHL) - 2 salinan

2 2 Borang KWSP 3A (AHL) - 1 salinanForm KWSP 3A (AHL.) -1 copy

2 3 Salman muka hadapan Buku Akaun Bank yang mengandungi butir-butir akaun tuan/puan atauPenyata Akaun Bank Semasa yang asal Pemohon hendaklah menurunkan cap ibu jan kin dankanan di atas salinan tersebut Sekiranya tuan/puan menghantar melalui pos, salinan dokumenhendaklah disahkan oleh Pegawai Bank berkenaan dan sekiranya diserahkan di kaunter, silakemukakan dokumen asal beserta sahnannya bagi tujuan pengesahan oleh Pegawai Kaunter KWSPPhotostate copy of the front page of your bank book with details of your bank account number ox the originalcopy of your current Account Bank Statement Applicants are required to affix left and right thumb print impressionon copies of the document Please forward the ongmal document together with a photostate copy to be certifiedby the EPF Counter Officers at the counter Photostate copy of the bank book mus< be cenified true copy by therespective bank's officer if submission ii through post

3.0 PEGAWAI DAGANGEXPATRIATE

3 1 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport(Sila serahkan salinan pasport yang lama sekiranya nombor pasport terkini berbeza denqan rekod KWSP)Photostate copy of valid passport stating clearly your name and passport number(Please forward photostate copy of old passport if current passport number differs from EPF records)

3 2 Bukti penamatan kerjaProof of resignation/tenmnption of contract

- Surat penamatan kontrak oleh majikanAcceptance of resignation/termination of contract by employer

ATAUOR

- Penyata Perlepasan Cukai PendapatanIncome tax clearance lefer

3 3 Pembatalan permit kerja (Tidak malebihi 3 bulan dan tankh permohonan)Cancellation of work permit(Not exceeding 3 months from the date of application)

3 4 Sila bekalkan alamat ahli di luar negaraPlease give your overseas correspondence address

4.0 BEKAS WARGANEGARA MALAYSIArAYSIAN CITIZEN

4 1 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasportPhotostate copy of valid passport stating clearly your name and passport number

4 2 Surat Penyerahan Kad Pengenalan dan Pelucutan Kewarganegaraan danpada Pejabat Pendaftaran NegaraLetter of surrendenng of the Identity Card and renounciation of citizenship from the Registration Office

4 3 Sila bekalkan alamat ahli di luar negaraPlease give your overseas correspondence address

50 PEKERJA ASINGFOREIGN WORKER

51 Salman pasport yang masih sahlaku yang jelas menunjukkan nama dan nombor pasport

(Sila kemukakan salinan pasport yang lama sekiranya nombor pasport terkini berbeza dengan rekod KWSP)Photostate copy of valid passport stating clearly your name and passport number(Please forward photostate copy of old passport if current passport number differs from EPF recoros)

5 2 Sila bekalkan alamat ahli di luai negaraPlease give your overseas correspondence address

60 DOKUMENTAMBAHANADDITIONAL DOCUMENT

61 SIJII Perkahwinan(Sekiranya nama di dalam pasport berlainan dengan rekod KWSP)Marriage Certificate(If name in the passport aiffers from EPF records)

Tandatangan Ahli TankhVeinbf" > Signature Date

Tandatangan Penenma TankhRf teiver s Signature Date

KUMPULAN WANG SIMPANAN PEKERJA1 O&OS 2001


MENINGGALKAN NEGARA

KWSP 96 (AHL)PERCUMA

PERHATIAN • MANA-MANA ORANG YANG MEMBUAT APA-APA KENYATAAN YANG TIDAK B E T U L ATAU TIDAK BENAR ATAU MENGEMUKAKAN ATAU MEM6ERIKAN APA-APAIOKUMEN PALSU DALAM APA-APA BUTIR-BUTIR MUSTAHAK ADALAH MELAKUKAN KESALAHAN DAN AKAN MENYEBABKAN DIRINYA BOLEH DIDENOA ATAU DIPENJARA ATAU£DUA-DUANYA

ATTENTION ANY PERSON WHO MAKES ANY UNTRUE OR FALSE STATEMEN1S OR PRODUCES ANY FALSE DOCUMENTS REGARDING ANY MATERIAL PARTICUtARS IS COMMITTING AN OFFENCE ANO IF FOimO GUL TYSHALL BF LIABLE TO 'MPRISONMENT OR FINE OR BOTH

KEGUNAAN KWSP SAHAJAFOR EPF USE ONLY

KPDC

nxo

MOD PEMBAYARAN

MODE OF PAYMEN1

WARANWARRANT

ORAFBANKAS'NGFORE'GN BANK DRAFT

APAHAN BAYARAN] tW'KWlFSS

P K R F D I T K E AKAUN BANKDIRECCREDITING

j c M b AKAUNYPE OF ACCOUN1

KONVtNSIONAI CONVENTIONAL

[ ALWADIAHL ALWADIAH

DISEMAK OLEHPEGAWAI PENYEMAK

CHECKED BY OFFICER IN CHARGE

IAWKHOATt

BUTIRANAHLIPARTICUIARS OF MEMBER

1 NOMBORAHUMtMBERS NUMBER

J2 NOMBOR KAD PENGENALAN 12 DIGIT

<1 DIGIT IDENTITY CARD NUMBER

OUT3. NOMBOR KAD PENGENALAN 7 DIGIT7 DIGI1 IDENTITY CARD NUMBER

4 NOMBOR POLIS/TENTERA/PASPORT/DSBPOLICEMUTARY/PASSPORTNUMBER/ETCnxxxixx

5 NAMA MENGIKUT KAD PENGENALAN/PASPORTNl^MF AS PER THE APPLICANTS IDENTITY CARD/PASSPORT

6 KETURUNANRACE

n

7 TARIKHL/HIRDATEOF8IR~H

TV

I J\N1INAGENDER

9 SEKTOR PEKERJAANEMPLOYMENT SECTOR

H0

HD

BM

8M

LELAKIMALE

PEREMPUANFEMALE

BCKERJASENDIRii f ( . f EMPLOYED

KERAJAANGOVERNMENT

SWASTAPRIVATE

TIDAK BEKERJAUNEMPLOYED

10 ALAMATArlUMEMBER S ADDRESS

POSKODPOSTCODE

BANDARCITY

NEGERISTATE

nzninzinin "i_ nzn :n _ m11 NOMBOR TEL EF ON PEJABAT

OFHCt IELEPHO'IE NUMBER

12 JENIS PEMBAYARANDPC OF PAYMENTrrxx

NOMBOR IFLEFON RUMAH

'ESIDlNCEJTLEPHONEI UMBER/HANWHONE

J L J

vVARANWARRANT

DRAFBANKASINCFOREIGN BANK DRAF i

ARAHAN BAYARANWARRANTLESS

KREDIT KE AKAUN BANKDIRECT CREDITING

BUTIRAN AKAUN BANKPAPTICULARS OFBANKACK-OUNI

13 KODBANKBANK CODE

14 NOMBOR AKAUN BANKBANKAt^OLNlNbMbER

xixixxLxn15 JENbAKALNTYPE OF ACCOUM

KONVENSIONALCONVENTIONALAL WADIAHAL WADIAH

PEMBERITAHUAN :OISAHKAN OLEH:

PEGAWAI PENGESAHNOTIFICATIONVERIFIED BY

OFFICER IN-CHARGE

NO K/TGNSTAFF REF NO

TARIKHDATE

DILULUSKAN OLEH :PEGAWAI PELULUS 1

APPROVED ByAPPROVAL OFFICER 1


TARIKHDATE

PEGAWAI PELULUS 2APPROVAL OFFICER 1


TARIKHDATS

SAYA DENGAN INI MEMOHON UNTUK MENGELUARKAN KREDIT SAYA Dl KWSP MENURUT PERUNTUKAN AKTA KWSP 1991./ HEREBY APPLY TO WITHDRAW VY EPF CREDIT IN ACCORDANCE WITH THE EPF ACT 13S1

16.

JENISPENGELUARAN

TYPE OFWITHDRAWAL

NOMBORAHLIMEMBER'S NUMBER

T

CAP IBU JARI KIR! DANKANAN AHLI

(MESTI DITURUNKAN DENGANTERANG DAN PENUHMENGGUNAKAN PAD

CAP IBU JARI BERWARNAHITAM1

LEFT AND RIGHT THUMB IMPRESSIONOF THE MEMBER

(MUST BE CLEARLY AND FULL YAFFIXED USING BLACK INK

THUMBPRINT PAD)

TARIKHDATE

I H H NOMBOR K/PH § IDENTITY CARDj g j j j NUMBER

KlfilLEEI

mmBlSiU

17. AKUAN SAKSIWITNESS DECIMATION

"SAYA DENGAN INI MENGAKU DAN MENGESAHKAN BAHAWA BUTIR-BUTIR PEMOHON TERCATAT Dl ATAS ADALAH MENGIKUT KADPENGENALAN MALAYSIA / SINGAPURA / POLIS / TENTERA / PASPORT YANG SAVA TELAH PERIKSA SENDIRI DAN PEMOHON TELAHMENURUNKAN CAP IBU JARI KIRI DAN KANANNYA Dl HADAPAN SAYA"

POLICE I MILITARY IDENTITY CARD I PASSPORT THAT I HAVE PERSONALLY EXAMINED AND THAT HE I SHE HAS DULY AFFIXED HIS I HER LEFT AND RIGHTTHUMB IMPRESSION BEFORE ME '

NAMA PENUH SAKSIFULL NAME OP WITNESS

NO KAD PENGENALAN SAKSIIDENTITY CARD NO OF WITNESS

ALAMAT SAKSIADDRESS OF WITNESS

TANDATANGAN SAKSISIGNATURE Of WITNESS

JAWATAN DAN COP RASMIDESIGNATION AND OFFICIAL STAMP

TARIKHDATE

NOTA ;ttSSE

BERIKUT ADALAH SENARAI ORANG YANG BOLEH MENJADI SAKSITHE FOLLOWING PERSONS MAY ACT AS A WITNESS

1 PEGAWAI KWSP YANG TERDIRI DARIPADAEPF OFFICER

PEGAWAI KWSP GRED 18 KE ATASEPF OFFICER GRADE (8 AND ABOVE

PEGAWAI KAUNTER KWSPEPF COUNTER OFFICER

2 MAJIKAN PEMOHONAPPLICANTS EMPLOYER

3 PEGAWAI KEDUTAAN MALAYSIAMALAYSIAN EMBASSY OFFICER

i NOTARIAWAMPUBLIC NOTARY

PANDUAN UNTUK MENGISI BORANG KWSP 9B (AHL)PEMBERITAHUAN PENGELUARAN MENINGGALKAN NEGARA

GUIDELINES TO COMPLETE FORM KWSP 9B(AHL)LEAVING COUNTRY WITHDRAWAL

SILA BACA PANDUAN INI DENGAN TELITI SEBELUM MENGISI BORANG. BORANG PERMOHONAN MESTILAH DIPENUHIDENGAN HURUF BESAR.PLEASE READ THESE GUIDELINES CAREFULLY BEFORE COMPLETING THE FORM. THE FORM MUST BE COMPLETED IN BLOCK LETTERS.

1 Nombor AhliMember Number

Isikan satu digit di setiap ruang dengan di dahului oleh digit '0' jika perlu, seperti contoh di bawahFill in the space with one number, starting with '0' as shown belowContoh . 1234567Example 1234567

1. NOMBOR AHLIMEMBER'S NUMBER

0

Nombo

1

Kad

2 3 4

Penaenalan 1212-Diait Identitv Card Number

5

Diqit

6 7

Isikan nombor Kad Pengenaian 12 digit tuan/puan Jika tuan/puan belum memiliki Kad Pengenalan 12 digit, kosongkanruangan miFill in your 12-digit Identity Card number Leave this space blank if you do not have any

Contoh 610701-02-6157Example 610701-02-6157

2. NOMBOR KAD PENGENALAN 12 DIGIT12 DIGIT IDENTITY CARD NUMBER

6 1 0 7 0 1 0 2 6 1 5

Nombor Kad Pengenalan 7 Digit / Polis/ Tentera/ Pasport / Dsb7-Digit Identity Card / Police/ Military/ Passport Number/ Etc

Isikan Nombor Kad Pengenalan 7 Digit termasuk huruf awalan, seperti contoh di bawahFill m /our 7-digit Identity Card number,mcluding the initial as shown below

a) 1234567

h) A1234567

c) K1234567

d) H1234567

3. NOMBOR KAD ^ENGENALAN 7 DIGIT7 DIGIT IDENTITY CARD NUMBER

4. Nombor Polis/Tentera/Pasport/DsbPolice/Military/Passport Number/Etc

Isikan Nombor Polis/Tentera/Pasport/Etc termasuk huruf awalan, seperti contoh di bawahFill in your police/military'/passport number/etc, including the mtial as shown below

4. NOMBOR POLISH TNTERA/PASPORT/DSBPOLICE/MILITARY/PASSPORT NUMBER/ETC

a) I 1234567

b) T 1234567

Nama Mengikut KadName As Registered In Identity Card I Passport

Tuliskan nama tuan/puan sebagaiinana yang tercatat dalam kad pengenalan tuan/puan Jika nama mengikut kad penqenalanlalah Norman bin Abdullah sha tuliskan nama seperti di bawahWrite your name as registered in your identity card If your name as per your identity card is Norman bin Abdullah, pleasecomplete your name as follows

i r

!

M

HA

5

N

NAMA MENGIKUT KAD PENGENALAN / PASPORTNAME AS PER IDENTITY CARD / PASSPORT

B•

N A B D U L L A H

Keturunan

Isikan ruang dengan mengikut kod keturunan di bawah mi Jika tuan/puan berketurunan Melayu, isikan seperti di bawah

Please complete this portion with rpference to the following For instance ifyou are a Malay

6. KETURUNANRACE

Melayu

Malay

CinaChinese

IndiaIndian

Lam-lam

Others

Tarikh LahirDate of Birth

1

2

3

4

BidayuhBidayuh

Kadazan

Kadazan

IbanIban

Isikan tankh lahir tuan/puan mengikut susunan han, bulan dan tahun Jika tankh lahir tuan/puan pada 1 Julai 1961, isikan seperti di bawahFill in your date of birth according to the date, month and year If your date of birth is 1« July 1361, please fill in as follows

7 TARIKH LAHIRDATE OF BIRTH

H

D

0

H

D

1

B

M

0

B

M

7

T

Y

6

T

Y

1

Jantinagender

Tandakan jantina tuan/puan dengan [•/) dalam ruang yang disediakan Jika lelaki, tandakan {•/) di ruang yang berkenaan

seperti di bawah

Please tick{S) whichever is applicable Ifyou are a male, please fill in as follows

8. JANTINAGENDER

LELAKIMALE

PEREM°UANFEMALE

9. Sektor Pekerjaan AhliEmployment Sector

Tandakan {/) dalam ruang yang disediakan JiKa tuan/puan bekerja dalam seklor swasta, tanda (V) dalam ruang yangberkenaan seperti di bawahPlease tick {/) whichever is applicable If you are working in the pnvate sector, please fill in as follows

9. SEKTOR PEKERJAANEMPLOYMENT SECTOR

BEKERJA SENDIRISELF EMPLOYEDKERAJAANGOVERNMENT

SWASTAPRIVATETIDAK BEKERJAUNEMPLOYED

•

10. AlamatAhliMember's Address

Tuliskan aiamat surat menyyat tuan/puan dengan lengkap Jika alamat surat menyurat tuan/puan adalah Lot 10, Kg PantKadir rmiur, Bukit Pasir, 84300 Muar, Johor Darul Takzim, sila penuhi seperti DerikutPlease complete yow full address If your address is Lot 10, Kg Pant Kadir Timur, Bukit Pasir, 84300 Muar, Johor Darul Takzimplease fill in as follows

II

10. ALAMAT AHLIMEMBER'S ADDRESS

P A R I T

M|U [ R iS I U K I [ M [ P IA | S 1I I I I I L I I I I I i i __i L _J

POSKODPOSTCODE

NEGERISTATE

[7

BANDARCITY

O I R

i

Z I M

11. Nombor Telefon AhliMember's Telephone Number

Isikan nombor telefon di ruangan yang disediakan di bawahContoh Nombor Telefon Pejabat 07 • 9859450 dan Nombor Telefon Rumah/Bimbit 016-2070158Please complete your telephone number (if any) as followsFor example Office Telephone Number 07 • 9859450 and Residence Telephone Number I Handphone 016 - 2070158

11. NOMBOR TELEFON PEJABATOFFICE TELEPHONE NUMBER

NO TELEFON RUMAH/BIMBITRESIDENCE TELEPHONE NUMBER /HANDPHONE

2 0

12. Jenis PembayaranType Of Payment

Jika tuan/puan memilih kaedah pembayaran kredit ke akaun bank, tanda ( / ) di ruang yang berkenaan seperti di bawah :If you choose direct crediting, pleas$ tick ( • ) as below:

12. JENIS PEMBAYARANTYPE OF PAYMENT

WARANWARRANT

DRAFBANKASINGFOREIGN BANKDRAFT

ARAHAN BAYARANWARRANTLESSKREDIT KE AKAUNBANKDIRECT CREDITING

• /

0 2

13. KalBankBqnl{ Code

Isikan nombor kod bank di ruangan yang disediakan seperti di bawah :

Please fill in the bank code number in the space below:

13. KOD BANKBANK CODE

Kod

Code

0102030405060708

Nama BankName of Bank

RHB Bank

Maybank

Bumiputra CommercePublic BankHong Leong BankHong Leong FinanceAffin BankEON Bank

Nama Bank

Name of Bank

Arab Malaysian Bank

Alliance BankSouthern Bank

Utama BankBank Muamalat

Arab Malaysian FinanceBank Islam

KodCode

09101112131415

14. Nombor Akaun BankBank Account's Number

Jika nombor akaun bank adalah 1-23456 -789012-3, isikan ruangan berkenaan seperti di bawah:

If your bank account's number is 1-23456-789012-3, please fill in as below:

15.

1 2 3 4 5 6 7 8 9 0 1 2 3

Jenis AkaunType of Account

Jika akaun tuan/puan adalah jenis konvensional, tanda (V) di ruang yang berkenaan seperti di bawah:

Please tick (</) as below, if your type of account is conventional:

KONVENSIONALCONVENTIONAL

AL-WADIAHAL-WADIAH

•

16. Jenis Pengeluaran, Nombor Ahli, Nombor Kad Pengenalan dan Cap Ibu JariType of Withdrawal. Membership Number. Identity Card Number and Thumb Impression

Isikan jenis pengeluaran, nombor ahli dan nombor kad pengenalan serta turunkan cap ibu jari kiri dan kanan tuan/puan dengan

terang dan penuh menggunakan Pad Cap Ibu Jari berwarna hitam.

Kindly fill in type of withdrawal, membership number, identity card number and left and right thumb impression. The impression

must be clear and fully affixed using black ink thumbprint pad.

17. Afcuan SakalWitness Declaration

Senarai orang yang boleh menjadi saksi adalah seperti berikut:The following persons may act as a Witness:

1. PegawaiKWSPterdiridaripada: 3. Pegawai Kedutaan MalaysiaEPF Officer Malaysian Embassy Officer

• Pegawai KWSP Gred 18 Ke atasEPF Officer Grade 18 and above

- Pegawai Kaunter KWSPEPF Counter Officer

2. Majikan Pemohon 4. Notari AwamApplicant's Employer Public Notary

etr mohamad shukry_b._maksah_05

Economy & Finance