ADMINISTRATIVE PROCEDURE

Certificate of facts for which official records are kept

(Article 174 LGAP (Law on General Administrative Procedure)).
_________________________________________________
(Name and address of the body)

Number_______________
Date__________________

__________________________________________________________________________
(Name of the issuing authority) (Name of the body that issues the certificate)
Based on Article 174 of the Law on General Administrative Procedure (Government Gazette of RM No.
38/05), at the request of ________________________________________________________________
(Name and surname of the party)

CERTIFICATE
It is confirmed that
____________________________________________________________________________________
(Facts that are confirmed by official records)
This certificate is issued on the basis
of___________________________________________________________________________________
_________________________________________________________________________________
(Name of official records and detailed data - year, for which records are kept, page, ordinal number
etc...)

and serves for ___________________________________________________________________

(Basis for payment of the fee and the amount of the fee, or tax exemption)
L.S. (place of the seal))
______________________
(Signature)