BEM On The Rock — Maklumat Kematian

A

Maklumat Waris / Heir Information

Maklumat individu yang mengisi borang ini.

Information of the person filling in this form.

Adakah anda berdaftar sebagai anggota gereja BEM On The Rock? / Are you registered as a member of BEM On The Rock? *

Ya / Yes Tidak / No Saya tidak beribadah di BEM On The Rock [Orang luar] / I don't pray in BEM On The Rock [Outsider]

No. ID / IC No. *

Nama Penuh / Full Name *

No. ID / IC No. *

No. Telefon / Phone No. *

Alamat / Address *

Apakah hubungan anda dengan si mati? / What is your relationship with the deceased? *

B

Maklumat peribadi dan berkenaan kematian si mati.

Personal information and death details of the deceased.

Bahagian 1: Maklumat Peribadi Si Mati / Part 1: Personal Information of the Deceased

Nama Penuh Si Mati / Full Name of the Deceased *

No. ID / IC No. *

Jantina / Gender *

Lelaki / Male Perempuan / Female

Bangsa / Race

Alamat / Address

Bahagian 2: Maklumat Berkenaan Kematian / Part 2: Information Regarding the Death

Tarikh Meninggal Dunia / Date of Passing *

Punca Kematian / Cause of Death

Nombor Lot Kubur / Grave Lot Number

Saya mengaku bahawa butiran yang diberikan adalah benar. / I declare that the details provided are true.

C

Butiran berkenaan upacara pengebumian si mati.

Details regarding the funeral service of the deceased.

Tarikh Dikuburkan / Date of Burial

Dijalankan Oleh / Conducted By

No. Tel Pengendali / Conductor's Phone No.

Disaksikan Oleh / Witnessed By

No. Tel Saksi / Witness's Phone No.