2016 SCHOLARSHIP APPLICATION FORM

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    12-Jan-2017

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    2016 SCHOLARSHIP APPLICATION FORM Borang Permohonan Biasiswa

    Please send this completed form to / Sila hantarkan borang yang lengkap kepada :

    MNRB Scholarship Fund 11

    th Floor, Bangunan Malaysian Re, No. 17, Lorong Dungun, Damansara Heights, 50490 Kuala Lumpur

    Tel: 03-20967160 / 20967028 Fax: 03-20930368 E-mail: scholarship@mnrb.com.my

    (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 / Course Keputusan / 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

    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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