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2017 SCHOLARSHIP APPLICATION FORM Borang Permohonan Biasiswa
Please send this completed form to / Sila hantarkan borang yang lengkap kepada :
MNRB Scholarship Fund 11th Floor, Bangunan Malaysian Re, No. 17, Lorong Dungun, Damansara Heights, 50490 Kuala Lumpur
Tel: 03-20967160 / 20967028 Fax: 03-20930368 E-mail: [email protected]
(All information / data which is obtained may be assessed, processed, analyzed and stored by the Board of Trustees in accordance with the Personal Data Protection Act 2010 (PDPA))
A) PERSONAL DETAILS / Keterangan Diri Pemohon Full Name / Nama Penuh
Permanent Address / Alamat Tetap
Telephone Number (Home) / Nombor Telefon (Rumah) Age / Umur New NRIC / Kad Pengenalan (Baru)
Handphone Number / Nombor Telefon Bimbit E-mail / E-mel
Nationality /Warganegara Race / Bangsa Malaysia Malay / Melayu Indian / India
Others /Lain-lain Chinese / Cina Others / Lain-Lain
Marital Status / Taraf Perkahwinan
Single / Bujang
Others / Lain-lain Female / Perempuan Male / Lelaki
Physical Disabilities (if any) (eyesight, hearing, speech, etc.): Kecatatan fizikal (jika ada) (seperti penglihatan, pendengaran, percakapan dll):
B) ACADEMIC QUALIFICATIONS / Kelayakan Akademik
Year/ Tahun
*Results / Qualification / CourseKeputusan / Kelayakan / Kursus
*CGPA / PNGK
School / Institution Sekolah /Institusi
SPM -
STPM -
Matrics
Diploma
Degree
Others
*Please enclose certified copies of transcripts / Sila lampirkan salinan transkrip yang telah disahkan
C) EXTRA CO-CURRICULUM ACTIVITIES / SPORTS (Last 2 years only)
Kegiatan Ko-kurikulum / Sukan (2 tahun yang lepas)
Year /Tahun Position / Jawatan Society/Club / Persatuan/Kelab
If the space above is insufficient, please continue on a separate sheet of paper / Jika ruang di atas tidak mencukupi, sila sambung dilampiran yang berasingan
Colour
passport-sized photo
Gambar warna berukuran paspot
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D) CURRENT OR PREFERRED FIELD OF STUDY (Please tick)
(Bidang pengajian yang sedang atau ingin diceburi. Sila tandakan dibawah) Risk Management / Pengurusan Risiko
Matriculation /
Foundation Degree
Insurance / Insurans
Matriculation / Foundation
Degree
ACCA / ACCA
ACCA
Information Technology / Teknologi Maklumat
Matriculation / Foundation
Degree
Actuarial Science / Sains Aktuari
Matriculation / Foundation
Degree
Shariah / Shariah
Matriculation / Foundation
Degree
Please enclose a copy of the acceptance letter from relevant institutions / universities, if available.
Sila lampirkan salinan surat tawaran daripada institusi/universiti, jika ada.
Expected / Actual Date of Commencement of Study
Tarikh Sebenar/Jangkaan Permulaan Pengajian
Duration of Study Tempoh Pengajian
Expected / ActualDate of Completion of Study
Tarikh Sebenar/Jangkaan Tamat Pengajian
E) ESSAY / Esei
Please attach a HANDWRITTEN essay in English, NOT EXCEEDING 500 WORDS, describing reasons for applying for this scholarship, benefits from the course of study including education and career plans. Sila lampirkan sebuah esei Bahasa Inggeris, secara BERTULIS dan TIDAK MELEBIHI 500 PERKATAAN menghuraikan sebab-sebab anda memohon biasiswa ini, faedah yang diperolehi dari bidang yang dipelajari serta rancangan pengajian dan kerjaya.
F) Have you received any offer of scholarship or other forms of financial assistance from other parties? If YES, please give details. Adakah anda menerima tawaran biasiswa atau sebarang bantuan kewangan dari pihak lain? Jika YA, sila nyatakan.
G) FAMILY DETAILS / Keterangan Keluarga
Parents / Guardian & Siblings’ Names Nama Ibubapa / penjaga & adik beradik
Relationship Hubungan
Occupation Pekerjaan
If the space above is insufficient, please continue on a separate sheet of paper / Jika ruang di atas tidak mencukupi, sila sambung dilampiran yang berasingan.
H) DECLARATION /Deklarasi
I declare and confirm that all information as stated above is true and correct. Saya mengaku dan mengesahkan bahawa segala keterangan yang diberikan di atas adalah sahih dan benar
SIGNATURE/ Tandatangan DATE/ Tarikh