Application Car Access Card FORM A
Application Car Access Card FORM A
Application Car Access Card FORM A
DAnjung Teluk Pulai Neighbourhood Security Scheme- Purchasing Wave access card
Item First Two (2) Cards Subsequent Cards Damage or Lost Cost RM 35.00 Per Card RM 50.00 Per Card RM 100.00 Per Card
Please fill in the details below: How many Card you would like to Purchase Cards
NAME 1. 2. 3. 4. 5. 6. 7.
ADDRESS
REGISTER NO:
Note: 1. Each Name Application must be enclosed with photocopy NRIC. Strictly for Purchasing Resident and their family members living in the same house ONLY. Wave access card & Motorbike sticker is for the usage of DAnjung Teluk Pulai residence only. The access will be revoked if found there is misuse of these items. I, undersign hereby enclose Cheque Cash for amount of RM..............................Made payable to "Persatuan Penduduk D'Anjung Teluk Pula Klang" being the purchase of wave Access Card. Name: (.) IC NO: (.) Date: (//12.) Approved by . Date:/./12..