Course Registration - Pelita Mas Laut Maritime Training Institution

CAWANGAN/ BRANCH: *

TARIKH KURSUS/ COURSE DATE: *

KURSUS/ COURSE (SIBU): *

KURSUS/ COURSE (MIRI): *

KURSUS/ COURSE (KOTA KINABALU): *

NAMA PENUH/ FULL IN NAME: *

NO. KAD PENGENALAN/ IDENTIFICATION CARD NO./ NO. PASSPORT/ PASSPORT NO: *

NO. KAD PELAUT/ SEAMAN CARD NO.: *

NO. TELEFON/ TELEPHONE NO. *

WARGANEGARA/ NATIONALITY: *

ALAMAT SURAT MENYURAT/ POSTAL ADDRESS: *

ALAMAT EMEL/ E-MAIL ADDRESS

NAMA WARIS/ NAME OF NEXT KIN: *

NOMBOR TELEFON WARIS/ CONTACT OF NEXT KIN: *

PEMBAYARAN KURSUS/ COURSE PAYMENT: *

RESIT PEMBAYARAN/ PAYMENT RECEIPT: *

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SILA BAYAR YURAN KURSUS KE ACCOUNT/ PLEASE PAY THE COURSE FEE TO (MAYBANK) (PELITA MAS LAUT SDN. BHD) (511056331274) (SILA PASTIKAN GAMBAR RESIT PEMBAYARAN YANG DIMUAT NAIK ADALAH JELAS/ PLEASE MAKE SURE THE IMAGE OF PAYMENT RECEIPT UPLOADED IS CLEAR.) (.JPG/ .PDF SAHAJA/ ONLY, TIDAK LEBIH DARI 1MB/ NOT MORE THAN 1MB)

TAJAAN SYARIKAT/ COMPANY SPONSORED *