AKUAN BERTULIS PELAJARSMKA SHEIKH HAJI MOHD SAID SEREMBAN

NAMA PELAJAR :…………………………………………………………………………………………………………………NO I/C :…………………………………………………………………………………………………………………TINGKATAN :………………………………………….. DORM :……………………………………….NAMA PENJAGA :…………………………………………………………………………………………………………………ALAMAT PENJAGA :…………………………………………………………………………………………………………………

………………………………………………………………………………………………………………….NO. TEL. RUMAH :………………………………………….. H/P :……………………………………….

Pengakuan saya seperti berikut:

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Akujanji saya:

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Saya sedia menerima sebarang TINDAKAN TEGAS oleh pihak sekolah sekiranya saya mengulangi perbuatan yang sama pada masa akan datang.

Yang Benar, Disahkan oleh,

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Tarikh :……………………….Hari :……………………….