{"id":9812,"date":"2019-12-26T08:07:19","date_gmt":"2019-12-26T08:07:19","guid":{"rendered":"https:\/\/koopguru.com.my\/new\/?page_id=9812"},"modified":"2024-01-14T02:48:16","modified_gmt":"2024-01-14T02:48:16","slug":"borangtka","status":"publish","type":"page","link":"https:\/\/koopguru.com.my\/new\/borangtka\/","title":{"rendered":"borangtka"},"content":{"rendered":"<p>[vc_row css=&#8221;.vc_custom_1578194582403{padding-top: 65px !important;}&#8221;][vc_column][vc_text_separator title=&#8221;Ruang Bertanda * Wajib Diisi&#8221; color=&#8221;mulled_wine&#8221; style=&#8221;shadow&#8221; border_width=&#8221;2&#8243;][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1578194749337{padding-bottom: 65px !important;}&#8221;][vc_column width=&#8221;1\/6&#8243;][\/vc_column][vc_column width=&#8221;2\/3&#8243;]\r<!-- rt-cf7 -->\r<div class=\"radiant-contact-form rte78f0044d944fb0 element-one \"  ><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f9849-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><\/div>\n<form action=\"\/new\/wp-json\/wp\/v2\/pages\/9812#wpcf7-f9849-o1\" method=\"post\" class=\"wpcf7-form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"9849\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.1.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f9849-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"g-recaptcha-response\" value=\"\" \/>\n<\/div>\n<p><b> 1. KENYATAAN DIRI ANGGOTA<\/b><\/p>\n<div class=\"row\">\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap Nama\"><input type=\"text\" name=\"Nama\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp; Nama Penuh:(*)\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap email\"><input type=\"email\" name=\"email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Email:(*)\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap icbaru\"><input type=\"text\" name=\"icbaru\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Kad Pengenalan Baru: (*)\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap noanggota\"><input type=\"tel\" name=\"noanggota\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;No.Anggota:(*)\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap jawatan\"><input type=\"text\" name=\"jawatan\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Jawatan Hakiki:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-12 col-md-12 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap addofis\"><textarea name=\"addofis\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Alamat Sekolah \/ Pejabat :(*)\"><\/textarea><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap phoneofis\"><input type=\"tel\" name=\"phoneofis\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;No.Tel Sekolah \/ Pejabat:(*)\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-12 col-md-12 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap addtetap\"><textarea name=\"addtetap\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Alamat Tetap :(*)\"><\/textarea><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap phonebimbit\"><input type=\"tel\" name=\"phonebimbit\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;No.Tel Bimbit:(*)\" \/><\/span>\n<\/div>\n<\/div>\n<\/div>\n<p><br><\/br><\/p>\n<p><b> 2. SILA ISI JIKA ISTERI\/SUAMI ANGGOTA KOPERASI<\/b><\/p>\n<div class=\"row\">\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap Namapasangan\"><input type=\"text\" name=\"Namapasangan\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Nama Penuh:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap nopasangan\"><input type=\"tel\" name=\"nopasangan\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;No.Anggota:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap icbarupsg\"><input type=\"text\" name=\"icbarupsg\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Kad Pengenalan Baru:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap phonepsg\"><input type=\"tel\" name=\"phonepsg\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;No.Tel Bimbit:\" \/><\/span>\n<\/div>\n<\/div>\n<\/div>\n<p><br><\/br><\/p>\n<p><b>3. MAKLUMAT ANAK\/PASANGAN BUKAN AHLI<\/b><\/p>\n<div class=\"row\">\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap Namaanak\"><input type=\"text\" name=\"Namaanak\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Nama Penuh:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap nosijil\"><input type=\"text\" name=\"nosijil\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;No. Sijil Lahir:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap icanak\"><input type=\"text\" name=\"icanak\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Kad Pengenalan Baru:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap umur\"><input type=\"text\" name=\"umur\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Umur:\" \/><\/span>\n<\/div>\n<\/div>\n<\/div>\n<p><b> 4. KENYATAAN DIRI PERMOHONAN DIBUAT OLEH WARIS-WARIS (BUKAN ANGGOTA SENDIRI)<\/b><\/p>\n<div class=\"row\">\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap Namawaris\"><input type=\"text\" name=\"Namawaris\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Nama Penuh:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap icwaris\"><input type=\"text\" name=\"icwaris\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Kad Pengenalan Baru:\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-12 col-md-12 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap addwaris\"><textarea name=\"addwaris\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Alamat:\"><\/textarea><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap phonewaris\"><input type=\"tel\" name=\"phonewaris\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;No.Tel:\" \/><\/span>\n<\/div>\n<\/div>\n<\/div>\n<p><br><\/br><\/p>\n<p><b>5. BUTIRAN AKAUN<\/b><\/p>\n<div class=\"row\">\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap Namabank\"><input type=\"text\" name=\"Namabank\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;Nama Bank: (*)\" \/><\/span>\n<\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<span class=\"wpcf7-form-control-wrap noakaun\"><input type=\"text\" name=\"noakaun\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"&nbsp;&nbsp;No. Akaun: (*)\" \/><\/span>\n<\/div>\n<\/div>\n<\/div>\n<p><br><\/br><\/p>\n<p><b> 6. PERMOHONAN DERMA<\/b><\/p>\n<div class=\"row\">\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<p><b> Kematian :<\/b><\/p>\n<p><span class=\"wpcf7-form-control-wrap kematian\"><select name=\"kematian\" class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\"><option value=\"Sila Pilih\">Sila Pilih<\/option><option value=\"Anggota\">Anggota<\/option><option value=\"Suami\">Suami<\/option><option value=\"Isteri\">Isteri<\/option><option value=\"Anak\">Anak<\/option><\/select><\/span>\n<\/p><\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<p><b> Rawatan Hospital :<\/b><\/p>\n<p><span class=\"wpcf7-form-control-wrap hospital\"><select name=\"hospital\" class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\"><option value=\"Sila Pilih\">Sila Pilih<\/option><option value=\"Anggota\">Anggota<\/option><option value=\"Suami\">Suami<\/option><option value=\"Isteri\">Isteri<\/option><option value=\"Anak\">Anak<\/option><\/select><\/span>\n<\/p><\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<p><b> Rawatan Sakit Kritikal :<\/b><\/p>\n<p><span class=\"wpcf7-form-control-wrap kritikal\"><select name=\"kritikal\" class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\"><option value=\"Sila Pilih\">Sila Pilih<\/option><option value=\"Anggota\">Anggota<\/option><option value=\"Suami\">Suami<\/option><option value=\"Isteri\">Isteri<\/option><option value=\"Anak\">Anak<\/option><\/select><\/span>\n<\/p><\/div>\n<\/div>\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<p><b> Bencana Alam :<\/b><\/p>\n<p><span class=\"wpcf7-form-control-wrap bencana\"><select name=\"bencana\" class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\"><option value=\"Sila Pilih\">Sila Pilih<\/option><option value=\"Anggota\">Anggota<\/option><option value=\"Suami\">Suami<\/option><option value=\"Isteri\">Isteri<\/option><option value=\"Anak\">Anak<\/option><\/select><\/span>\n<\/p><\/div>\n<\/div>\n<\/div>\n<p><br><\/p>\n<p><b> Derma Bersara :<\/b><\/p>\n<p><span class=\"wpcf7-form-control-wrap dermabersara\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dermabersara[]\" value=\"Ya\" \/><span class=\"wpcf7-list-item-label\">Ya<\/span><\/label><\/span><\/span><\/span><br \/>\n<br><\/p>\n<p><b> PENTING :<\/b><\/p>\n<p><b> SILA MUATNAIK DOKUMEN YANG TELAH DISAHKAN <\/b><\/p>\n<p><br><\/p>\n<div class=\"row\">\n<div class=\"col-lg-6 col-md-6 col-sm-12 col-xs-12\">\n<div class=\"form-row\">\n<p>MUAT NAIK DOKUMEN 1 :(*)<\/p>\n<p><span class=\"wpcf7-form-control-wrap filetka1\"><input type=\"file\" name=\"filetka1\" size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\".pdf,.jpg\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\n<br><\/p>\n<p>MUAT NAIK DOKUMEN 2 :<\/p>\n<p><span class=\"wpcf7-form-control-wrap filetka2\"><input type=\"file\" name=\"filetka2\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.jpg\" aria-invalid=\"false\" \/><\/span><br \/>\n<br><\/p>\n<p>MUAT NAIK DOKUMEN 3 :<\/p>\n<p><span class=\"wpcf7-form-control-wrap filetka3\"><input type=\"file\" name=\"filetka3\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.jpg\" aria-invalid=\"false\" \/><\/span>\n<\/p><\/div>\n<\/div>\n<\/div>\n<p><span class=\"wpcf7-form-control-wrap acceptance\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">Saya mengaku segala keterangan yang diberikan adalah betul<\/span><\/label><\/span><\/span><\/span><\/p>\n<div class=\"col-lg-12 col-md-12 col-sm-12 col-xs-12\">\n<div class=\"form-row last button text-center\">\n<input type=\"submit\" value=\"Hantar\" class=\"wpcf7-form-control wpcf7-submit custom-btn-submit\" \/>\n<\/div>\n<\/div>\n<input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output wpcf7-display-none\"><\/div><\/form><\/div><\/div>\r<!-- rt-cf7 -->\r[\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row css=&#8221;.vc_custom_1578194582403{padding-top: 65px !important;}&#8221;][vc_column][vc_text_separator title=&#8221;Ruang Bertanda * Wajib Diisi&#8221; color=&#8221;mulled_wine&#8221; style=&#8221;shadow&#8221; border_width=&#8221;2&#8243;][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1578194749337{padding-bottom: 65px !important;}&#8221;][vc_column width=&#8221;1\/6&#8243;][\/vc_column][vc_column width=&#8221;2\/3&#8243;][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/koopguru.com.my\/new\/wp-json\/wp\/v2\/pages\/9812"}],"collection":[{"href":"https:\/\/koopguru.com.my\/new\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/koopguru.com.my\/new\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/koopguru.com.my\/new\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/koopguru.com.my\/new\/wp-json\/wp\/v2\/comments?post=9812"}],"version-history":[{"count":6,"href":"https:\/\/koopguru.com.my\/new\/wp-json\/wp\/v2\/pages\/9812\/revisions"}],"predecessor-version":[{"id":11473,"href":"https:\/\/koopguru.com.my\/new\/wp-json\/wp\/v2\/pages\/9812\/revisions\/11473"}],"wp:attachment":[{"href":"https:\/\/koopguru.com.my\/new\/wp-json\/wp\/v2\/media?parent=9812"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}