1. NAME
2. GENDER MALE FEMALE 3. AGE
4. I.D NUMBER/PASSPORT 5.OCCUPATION
6. CITIZEN 7. COUNTRY OF ORIGIN
8. ADDRESS
9. TEL. / HP NO. 10. FAX NO.
11. EMAIL
(Please provide proof/supporting documents/photo if available)
Acknowledgement : I hereby acknowledge that all information provided above is correct
Date : ____________________________ Signature : ______________________________
TYPE OF COMPLAINTS : COUNTER LETTER TELEPHONE EMAIL OTHERS Pls Specify ______________
Date : _______________________
_______________________________ (Name, Signature & Cop)
Action Taken : ___________________________ Type of Action : _________________________
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Tel : 03-8891 7000 Fax : 03-8891 7181 website : www.motour.gov.my email : info@motour.gov.my FOR OFFICIAL USE
PERSONAL PARTICULAR
STATEMENT OF COMPLAINTS
