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Page 1: 2017 SCHOLARSHIP APPLICATION FORM

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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


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