BORANG KEAHLIAN BORANG KEAHLIAN A. BORANG PENDAFTARAN KEAHLIANNAMA PENUH PEMOHON:(Required) First NO. KAD PENGENALAN:(Required) WARGANEGARA: JANTINA(Required) LELAKI PERAMPUAN STATUS PERKAHWINAN(Required) BERKAHWIN BELUM BERKAHWIN NO.TEL /B - 1:(Required)NO.TEL /B - 2:EMEL:(Required) NO. TEL (RUMAH):NO. TEL (PEJABAT):ALAMAT RUMAH:(Required) Line 1 Line 2 Bandar Negeri POSKOD AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Negara NAMA MAAHAD: HUBUNGAN PEMOHON DENGAN MAAHAD: B. JUMLAH BAYARAN YANG DISERTAKAN(i) BAYARAN MASUK / PENDAFTARAN Price: (ii) BAYARAN MASUK / PENDAFTARAN(Required) NOTA : PELABURAN MINIMUM SAHAM ADALAH RM500.00C. CARA BAYARAN DAN AGIHAN CARUMANPILIHAN CARA BAYARAN DIVIDEN (PILIH SATU SAHAJA) DAN TANDAKAN(Required) Dikreditkan ke akaun Bank Dipermodalkan (Tambah saham) NAMA BANK NO. AKAUN NOTA: 1. Bayaran boleh dibuat melalui cek/wang pos/bank draft kepada KOPERASI PERSATUAN INSTITUTI TAHFIZ AL-QURAN SELANGOR BERHAD (KOPITAS) atau secara deposit bank ke akaun Maybank KOPITAS (5624 5012 0835). 2. Keahlian KOPITAS berkuatkuasa setelah bayaran dijelaskan dan resit rasmi dikeluarkan. D. BUTIRAN WARIS UNTUK AGIHANBUTIR-BUTIR WARIS - 1NAMA NO.KAD NO. TELEFON BAHAGIAN(%) HUBUNGAN BUTIR-BUTIR WARIS - 2NAMA NO.KAD NO. TELEFON BAHAGIAN(%) HUBUNGAN BUTIR-BUTIR WARIS - 3NAMA NO.KAD NO. TELEFON BAHAGIAN(%) HUBUNGAN Total
