SURAT AKUAN / TESTIMONIAL                        Tarikh:
No.Pendaftaran Sekolah:  Tingkatan Tertinggi Tamat: .. Peperiksaan Tertinggi Diambil dan Tarikh: 
     School Admission No:                   Highest Form Attained:           Highest Examination Sat For and Date:
     Adalah diakui bahawa .No.K.P. . ...
     This is to certify that                                       Identity Card Number
     Adalah seorang murid sekolah ini dari .hingga..
     Is a pupil of his school from                                 to
     Tarikh Lahir ..
     Date of Birth
A.   PENILAIAN AKADEMIK (ACADEMIC ASSESSMENT)
                                                                PRESTASI                          ULASAN / COMMENTS
                                                              ACHIEVEMENT
          1.   KEBOLEHAN AKADEMIK
               ACADEMIC ABILITY
          2.   MINAT UNTUK BELAJAR
               INTEREST IN STUDIES
          3.   KERAJINAN
               INDUSTRY
B.   PENILAIAN GERAK KERJA KOKURIKULUM (ASSESSMENT OF CO-CURICULAR ACTIVITIES)
      BIL.      GERAK KERJA          TEMPOH KEAHLIAN       JAWATAN DIPEGANG                MINAT              ULASAN
      NO.        ACTIVITIES        PERIOD OF MEMBERSHIP         POST HELD                 INTEREST           COMMENTS
C.   PENILAIAN PERSONALITI/WATAK (EVALUATION OF PERSONALITY/CHARACTER)
        KELAKUAN       KEYAKINAN      DAYA USAHA    TANGGUNGJAWAB       KERJASAMA            PERGAULAN        PERAWAKAN
        CONDUCT       CONFIDENCE       INITIATIVE    RESPONSIBILITY    COOPERATION           SOCIALBILITY     APPEARANCE
     KUNCI PENILAIAN   1. Cemerlang        2. Baik             3. Sederhana    4. Kurang Baik          5. Lemah
     KEY TO ASSESSMENT   Outstanding          Above Average       Average         Below Average           Weak
     CATATAN KHAS (Jika ada)
     SPECIAL REMARKS (If any)_________________________________________________________________________________________
     ______________________________________________________________________________________________________________
                                                          
       GURU TINGKATAN / PENILAI                                                           PENGETUA
       FORM TEACHER / REFEREE                                                             PRINCIPAL
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