2016 SCHOLARSHIP APPLICATION FORM Borang Permohonan Biasiswa
Colour passport-sized photo Gambar warna berukuran paspot
Please send this completed form to / Sila hantarkan borang yang lengkap kepada : MNRB Scholarship Fund th 11 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
Handphone Number / Nombor Telefon Bimbit
Nationality /Warganegara Malaysia
New NRIC / Kad Pengenalan (Baru)
E-mail / E-mel
Race / Bangsa Malay / Melayu
Others /Lain-lain
Indian / India
Chinese / Cina
Others / Lain-Lain
Marital Status / Taraf Perkahwinan Single / Bujang Female / Perempuan
Others / Lain-lain
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 / Course Keputusan / Kelayakan / Kursus
*CGPA / PNGK
SPM
-
STPM
-
School / Institution Sekolah /Institusi
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
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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
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 / Actual Date of Completion of Study Tarikh Sebenar/Jangkaan Tamat Pengajian
E) ESSAY / Esei Please submit 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 (on a separate sheet of paper). 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 (di lampiran yang berasingan).
F) Have you received any offers of scholarship or other forms of financial assistance from other bodies? 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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