Sila tampalkan foto
SULIT/STRICTLY CONFIDENTIAL berukuran pasport
di sini
SECURITY SCREENING Please affix your
passport sized photo
PETRONAS EXECUTIVE STAFF here
1. a) Nama Penuh (huruf besar) :
(Full Name in Block Letters) …………………………………………………………………………………..
b) Nama Dalam Tulisan Cina :
(Name In Chinese Character) …………………………………………………………………………………..
c) Nama Lain (jika ada) :
(Other Names If Available) …………………………………………………………………………………..
2. Jantina : 3. Bangsa :
(Gender) …………………………………………… (Race) ……………………………………………………
4. Tarikh / Tempat Lahir :
(Date / Place of Birth) ………………………………………………………………………………………………………………...
5. a) Nombor Kad Pengenalan / Pasport :
(Identity Card / Passport No.) ………………………………………………………………………
b) Tarikh Kad Pengenalan Dikeluarkan / Tempat :
(Date / Place of Issue) ………………………………………………………….
6. Kewarganegaraan :
(Nationality) ………………………………………………………………………………………………………………...
7. No. Sijil Kerakyatan :
(Citizenship No. - Applicable to Malaysian Only) ………………………………………………………………………………………………
8. Alamat Sekarang :
(Current Address) ……………………………………………………………………………………………………
…………………………………………………………………………………………………....
9. Alamat Dahulu :
(Permanent Address) ……………………………………………………………………………………………………
……………………………………………………………………………………………………
10. Jawatan / Majikan Sekarang :
(Current Position / Employer) ………………………………………………………………………………………………
11. Jawatan / Majikan Dahulu :
(Previous Position / Employer ) ………………………………………………………………………………………………
12. a) Nama Bapa :
(Father’s Name) ……………………………………………………………………………………………………
b) Alamat :
(Address) ……………………………………………………………………………………………………
c) Pekerjaan :
(Occupation) ……………………………………………………………………………………………………
.......................................................... ....................................
Tandatangan Pemohon Tarikh
(Signature) (Date)
