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BORANG PENYERTAAN QURBANI
QURBANI PARTICIPATION FORM

1. Maklumat Peribadi / Personal Information

Nama/

Name:

Alamat/

Address:
Poskod:
No. KP:

E-mel/

Email :
Tel:  
Faks:
2. Saya mewakilkan pelaksanaan QURBAN bagi tahun 1431 Hijrah kepada Islamic Relief Malaysia Berhad atas nama-nama berikut / I appoint Islamic Relief Malaysia for my Qurbani 1431 Hijra implementation on names as below;
  Nama / Name

Negara / Country

 Harga (RM) / Price (RM)
(Please refer to the price list below)
1. =
2. =
3. =
4. =
5. =
6. =
7. =
     
3. Cara Pembayaran / Method of Payment
CIMB (1259 0000 804 058) / CIMB CLICKS
MBB (5621 4270 8704) / MAYBANK2U
Credit Card/Perbankan Internet/ Credit Card/Internet Banking: Ipay 88
4. Senarai Harga Qurban / Qurbani Price List