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    Borang KPKK11 Version English

    Uploaded by

    Rayyan
    This document contains a form (KPKK 11) for a service provider applying for a security clearance with the Chief Government Security Office in Malaysia. The form requests personal details like name, address, employer, passport information, and asks if the applicant has ever been convicted of fraud or dishonesty. Guidelines are provided for filling out the form correctly, including using block letters and black pen, attaching photos, including approval letters, and addressing the completed form to the listed security office address in Putrajaya, Malaysia.

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    © All Rights Reserved
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    Borang KPKK11 Version English

    Uploaded by

    Rayyan
    278 views2 pages
    This document contains a form (KPKK 11) for a service provider applying for a security clearance with the Chief Government Security Office in Malaysia. The form requests personal details like name, address, employer, passport information, and asks if the applicant has ever been convicted of fraud or dishonesty. Guidelines are provided for filling out the form correctly, including using block letters and black pen, attaching photos, including approval letters, and addressing the completed form to the listed security office address in Putrajaya, Malaysia.

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    Borang KPKK11 version english.doc

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    This document contains a form (KPKK 11) for a service provider applying for a security clearance with the Chief Government Security Office in Malaysia. The form requests personal details like name, address, employer, passport information, and asks if the applicant has ever been convicted of fraud or dishonesty. Guidelines are provided for filling out the form correctly, including using block letters and black pen, attaching photos, including approval letters, and addressing the completed form to the listed security office address in Putrajaya, Malaysia.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    278 views2 pages

    Borang KPKK11 Version English

    Uploaded by

    Rayyan
    This document contains a form (KPKK 11) for a service provider applying for a security clearance with the Chief Government Security Office in Malaysia. The form requests personal details like name, address, employer, passport information, and asks if the applicant has ever been convicted of fraud or dishonesty. Guidelines are provided for filling out the form correctly, including using block letters and black pen, attaching photos, including approval letters, and addressing the completed form to the listed security office address in Putrajaya, Malaysia.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    SULIT

    Chief Government Security Office (KPKK 11 FORM)


    Prime Minister Department
    SERVICE PROVIDER Recent
    passport size
    photograph
    PERSONAL PARTICULARS
    (Fill in the form in BLOCK LETTERS using a BLACK PEN)
    1. Current Position: ……………………………………………………………………………………………………………………………………………..................
    2. Employer: ………………………………………………………………………………………………………………………………………………………………………..
    3. Full Name: ……………………………………………………………………………………………………………………………………………………………………….
    4. Name in Chinese Characters (If applicable) :……………………………………Telephone No :………………………………………………………..
    5. Passport No: ……………………………………………………………………………………………………………………………………………………………………
    6. Sex :……………………………………Date/Place of Birth :…………………………………………………………………………………………………………….
    7. Nationality: ……………………………………………………………………………………………………………………………………………………………………..
    8. Residential Address: ………………………………………………………………………………………………………………………………………………………..
    ………………………………………………………………………………………………………………………………………………………………………………………..
    9. Correspondence Address: (If applicable):
    Address Date Started Until

    10. Name of Spouse (If applicable): ……………………………………………………………………………………………………....................................


    11. Identification No (NRIC): …..……………………………………………………………………………………………………………………………………………..
    12. Address: ………………………………………………………………………………………………………………………………………………………………………….
    …………………………………………………………………………………………………………………………………………………………………………………………
    13. Have you ever been convicted whether within or without Malaysia of any criminal offence under any written law
    involving fraud or dishonesty? If Yes, please state the offence(s): ……………………………………………………………………………………
    …………………………………………………………………………………………………………………………………………………………………………………………
    14. I hereby declare that all particulars given in this application form are to the best of my knowledge and belief true and
    correct. I understand that any misleading, willful omission and falsification or incorrect statement of fact may lead to the
    withdrawal of employment, or dismissal where employment has already commenced.

    Date: ……………………………………………… …………………………………………………


    (Signature of Applicant)
    15. Employer Acknowledgement
    I hereby acknowledge that the above named is employed by our company.
    Date: ………………………………………………
    Name: ……………………………………………...
    Position: ………………………………………….. …………………………………………………
    (Signature & Official Stamp)

    SULIT
    GUIDELINES FOR FILLING UP FORM (KPKK 11)

    1. Fill in the form (KPKK 11) in BLOCK LETTERS using a BLACK PEN.

    2. Two (2) copies of passport-sized coloured photograph.

    3. This form must be accompanied by approval/relevent authorities letter.

    4. While filling in the form, please pay attention to ensure all sections has been filled in. Only the completed

    form received will be processed and please address your application to:

    PEJABAT KETUA PEGAWAI KESELAMATAN

    KERAJAAN MALAYSIA

    JABATAN PERDANA MENTERI

    ARAS -1, 1 & 2, BLOK B7

    PUSAT PENTADBIRAN KERAJAAN PERSEKUTUAN

    62502 WILAYAH PERSEKUTUAN PUTRAJAYA

    Tel No. : 03-8872 6012 / 6021

    Fax No. : 03-8888 3270

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