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BAYARAN PROSES RM 10 PK-JKP-002/R1a Pindaan 01 MAJLIS PERBANDARAN JASIN, 77000 JASIN, MELAKA. BORANG PERMOHONAN LESEN IKLAN SEMENTARA SALINAN DOKUMEN YANG DIPERLUKAN A MAKLUMAT PEMOHON DAN SYARIKAT TANDAKAN ( √ ) Pemohon Pejabat 1 Sesalinan Kad Pengenalan 2 Sesalinan Pendaftaran Perniagaan (SSM) 3 Sesalinan Lesen Perniagaan (jika berkaitan) B MAKLUMAT LESEN DAN LESEN IKLAN Pemohon Pejabat 1 Sesalinan lakaran Iklan berwarna dengan penandaan saiz iklan dan tulisan 2 Sesalinan Sijil Pengesahan Bahasa dari Dewan Bahasa dan Pustaka (DBP) Permohonan online DBP : http://prpm.dbp.gov.my Pemohon Pejabat C PERAKUAN PEMOHON D KEPUTUSAN E STATUS PERMOHONAN 1 Lengkap Tidak lengkap 2 Tindakan : _______________________________________________________________________________________________ _____________________________________________________________ UTAMAKAN BAHASA KEBANGSAAN Perkataan dalam bahasa kebangsaan hendaklah diberi keutamaan termasuk saiz berbanding bahasa lain Disemak oleh Tandatangan & Cop jawatan Mukasurat 1/ 3 A. MAKLUMAT PEMOHON DAN SYARIKAT 1. Nama Syarikat/ Perniagaan 2. Nama Pemohon 3. No. K/P Baru No. K/P Lama - - 4. Alamat Surat Menyurat 5. Pekerjaan: Penjawat Awam/Swasta/Sendiri/Tidak Bekerja (*) 6. E-Mail (*) Sila potong mana yang tidak berkaitan 7. Warganegara 8. No. Telefon Bimbit No. Telefon (R/P) - - B. MAKLUMAT LESEN DAN LESEN IKLAN JENIS TEMPOH * JENIS IKLAN : BIL IKLAN SAIZ IKLAN IKLAN* PEMASANGAN 1. Kain rentang/ banner 5. Belon/ blim 2. Sepanduk 6. Lain-lain (Nyatakan) 3. Strima/ gegantung 4. Poster LOKASI PEMASANGAN IKLAN (*) Sila tanda kotak yang berkaitan 1. Kain rentang/ banner - Senarai Kerangka milik MPJ: Saiz: 20' x 4' Saiz: 12' x 4' Taman Maju Pekan Nyalas Spg ke Ayer Keroh-Pekan Bemban Taman Bahagia Taman Debunga, Merlimau Ukuran saiz: Taman Muhibbah Hadapan Kedai MPJ Umbai 40' x 10' Jalan Muar – Melaka Pekan Sungai Rambai 16' x 3' Pekan Bemban Lain-lain (Nyatakan) 16' x 4' Pekan Selandar 6' x 13' Pintu Masuk Pekan Umbai Lain-lain lokasi (nyatakan): Sempang Tangkak – Chohong Sempang Bekoh – Jalan Asahan 2. Strima/ gegantung : i. iv. vii. ii. v. viii. iii. vi. viv. Mukasurat 2/ 3 C. PERAKUAN PEMOHON Dengan ini saya bernama mengaku dan mengesahkan bahawa semua maklumat yang tercatat didalam borang ini dan lampiran-lampiran yang disediakan adalah benar belaka. Saya bersetuju sekiranya maklumat yang diberikan adalah palsu atau gagal mematuhi syarat-syarat permohonan Majlis berhak untuk membatalkan permohonan lesen ini Tandatangan pemohon atau cop syarikat/perniagaan Tarikh D. KEPUTUSAN (Untuk kegunaan pejabat) 1 Permohonan ini : DILULUSKAN DITOLAK kerana 2 Tempoh kelulusan : dari hingga No. akaun: 3 Bayaran : LESEN STIKER LAIN-LAIN SEWA KERANGKA 4 Syarat-syarat: Tarikh: Tandatangan & cop jawatan Tandatangan pengesahan Mukasurat 3/3 MAJLIS PERBANDARAN JASIN, 77000 JASIN, MELAKA. BORANG PERMOHONAN LESEN IKLAN SEMENTARA UTAMAKAN BAHASA KEBANGSAAN Perkataan dalam bahasa kebangsaan hendaklah diberi keutamaan termasuk saiz berbanding bahasa lain .

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Persatuan Geologi Malaysia
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