Bab E

Tandatangan Pegawai ............................................................................................. Nama Penuhnya ...................................................................................................... Jawatan .................................................................................................................... Tarikh........................................................................................................................ Kehilangan atau kerosakan diakui oleh saya. Tandatangan Pegawai yang menyerah rumah ........................................................ Nama Penuhnya....................................................................................................... Jawatan .................................................................................................................... Jabatan ..................................................................................................................... Tarikh ....................................................................................................................... * Jika semuanya teratur, tulis "Tiada" di ruangan kehilangan/kerosakan di atas. mukasurat 15