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(v) Hubungan/ Kaitan Dengan : ….................................................................
Pegawai
....................................................................
....................................................................
(vi) Sebab diberi ....................................................................
....................................................................
(vii) Lain-lain maklumat, jika ada ....................................................................
(seperti pandangan pegawai ....................................................................
tentang hadiah itu, sama ada
pegawai berkehendakkan ....................................................................
hadiah tersebut atau ....................................................................
sebagainya)

C. PERAKUAN PEGAWAI
Saya ........................................................... mengaku bahawa butir-butir yang diberi
di atas adalah benar.

Tarikh: .................................. ...........................................................
(Tandatangan Pegawai)

D. ULASAN KETUA JABATAN/CAWANGAN/UNIT, JIKA PERLU
............................................................................................................................
............................................................................................................................
............................................................................................................................

Tarikh: .................................. ...........................................................
(Tandatangan)
Nama :...............................................
Jawatan: ……....................................

18 POLISI PENGURUSAN HADIAH KEMENTERIAN SUMBER MANUSIA