Borang Ahli Seniman ( Page 1 )

(Borang 001)

(Fasal 7 ceraian I & II)

P E R S ATUAN S ENI MAN M AL AYS IA (ARTISTES ASSOCIATION OF MALAYSIA)

BORANG PERMOHONAN KEAHLIAN (SULIT)

Setiausaha Kehormat PERSATUAN SENIMAN MALAYSIA No. 301-C, Wisma PFM Melawati Square Lorong Perak Taman Melawati 53100 Kuala Lumpur Tel: 03-4105 5442

LEKATKAN GAMBAR TERBARU BERUKURAN PASPOT 2 KEPING

Tuan, Saya seperti keterangan di bawah ini memohon menjadi ahli dalam Persatuan Seniman Malaysia dan segala butir-butir serta keterangan yang dinyatakan di dalam Borang Permohonan Keahlian ini adalah benar belaka. Saya mengaku akan patuh dan menghormati segala ikhtiar yang dijalankan oleh Persatuan Seniman Malaysia. Nama Penuh ...................................................................................................................................................................................................................... (HURUF BESAR) Nama Professional ........................................................................................................................................................................................................... No. Kad Pengenalan: ................................................................................................. (Baru) ..................................................................... (Lama) Alamat Tetap: ..................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................. Tarikh Lahir: ........................................................................................................

No. Telefon: ...................................................................................

Tempat Lahir: .....................................................................................................

Jantina: ..........................................................................................

Taraf Perkahwinan: ..........................................................................................

Tinggi: ............................................................................................

Pekerjaan: ............................................................................................................ Berat Badan: ................................................................................. Alamat Majikan: ................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................. ........................................................................................................................................................ No. Telefon: ................................................................. Nama Isteri / Suami: .............................................................................................................. No. K/P: ......................................................................... Nama Pewaris: ........................................................................................................................ No. K/P: .......................................................................... Nama Anak NO.

NAMA

UMUR

SEKOLAH / BEKERJA

Pengalaman / Penglibatan Dalam Seni .................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................. Nyatakan Penghargaan / Anugerah Yang Pernah Diterima .................................................................................................................................................................................................................................................. ..................................................................................................................................................................................................................................................