MAJLIS PERBANDARAN KULAI Jalan Pejabat Kerajaan, 81000 Kulai, Johor

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MAJLIS PERBANDARAN KULAI Jalan Pejabat Kerajaan, 81000 Kulai, Johor. Tel: 07- 6631511, 07- 6632132, 07- 6637161 Faks: 07- 6632407 ___________________________________________________________________ BORANG PERMOHONAN PENYEWAAN DEWAN SERBAGUNA (TMN SENAI UTAMA / TMN SENAI BARU / TMN MEWAH / TMN SALENG/ TMN MANIS / SEDENAK / BUKIT BATU ) 1. Nama Pemohon : _____________________________________________ 2. Alamat Pemohon : ____________________________________________ ____________________________________________ ____________________________________________ 3. No. Telefon : ________________________ 4. No. Kad Pengenalan : ________________________ 5. Tarikh Digunakan : Dari ________________ hingga _______________ 6. Masa Digunakan : Dari ________________ hingga _______________ 7. Lokasi Dewan : _________________________________ 8. Tujuan Penggunaan : _________________________________ 9. Kadar Sewa : i. Dewan = RM150.00 ii. Wang Amanah = RM200.00 iii. Bil Air = RM80.00 iv. BilElektrik = RM100.00 _____________ ============ SYARAT-SYARAT PENYEWAAN DEWAN:- Saya bersetuju dan mematuhi segala syarat-syarat yang dikenakan sebagaimana berikut: a) Tidak boleh membawa masuk segala jenis minuman keras atau yang memabukkan. b) Tidak boleh membawa masuk makanan dari sumber daging khinzir dan yang dilarang oleh Agama Islam. c) Saya akan bertanggungjawab bagi apa-apa kehilangan atau kerosakan terhadap apa-apa barangan, alat perkakas atau kelengkapan dewan dalam tempoh sewaan. d) Saya hendaklah bertanggungjawab menjaga dewan supaya bersih dan semua sampah hendaklah dimasukkan ke dalam beg plastik hitam dan dibuang luar dari kawasan dewan. e) Yang DiPertua boleh membatalkan mana-mana jua permohonan yang diluluskan tanpa memberi apa-apa jua sebab berbuat demikian atau dengan satu notis bertulis kepada permohonan berkenaan. Majlis tidak bertanggungjawab bagi apa-apa jua akibat yang timbul dari pembatalan. f) Tidak boleh membawa masuk sebarang bentuk haiwan peliharaan. g) Sesiapa yang melakukan pelanggaran terhadap undang-undang kecil ini apabila sabit kesalahan boleh dikenakan denda tidak melebihi dua ribu ringgit atau penjara selama tempoh tidak melebihi setahun atau kedua-duanya sekali. Pihak Majlis juga berhak memotong bayaran wang amanah jika pihak tuan melanggar peraturan selepas dewan digunakan. 10. Saya bersetuju dan akan mematuhi syarat-syarat yang dikenakan. _________________ ______________________________ ___________________ Tarikh Tandatangan Pegawai Bertugas Tandatangan Pemohon _________________________________________________________________________________ Untuk kegunaan pejabat : Jenis Bayaran Tarikh Bayaran Jumlah Bayaran Status permohonan Diluluskan Sewa Wang Amanah Tidak Diluluskan Bil Elektrik Bil Air Sila tanda ( √ ) di ruang yang disediakan. .

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