Section 612

Jaya

PPBM 0639/08

No. 164, Jalan Orkid, Kg.

Murni Jaya,

81850 Layang-Layang,

Johor 8.10.2008

P.U. (B) 599 60

Bil./

Nama Pertubuhan

Berdaftar/

Name of Registered

Youth Societies

No. Sijil

Pendaftaran/

Certificate of

Registration No.

Alamat/

Address

Tarikh

Pendaftaran/

Date of