2014 Scholarship Application Form

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2014 Scholarship Application Form

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2014 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 11th Floor, Bangunan Malaysian Re, No. 17, Lorong Dungun, Damansara Heights, 50490 Kuala Lumpur Tel: 03-20967160 / 20967028 Fax: 03-20960368 E-mail: [email protected]

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 Malaysia Others /Lain-lain Marital Status / Taraf Perkahwinan Single / Bujang Others / Lain-lain

Race / Bangsa Malay / Melayu Chinese / Cina

Indian / India 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 SPM STPM Matrics Diploma Degree Master Others *Please enclose certified copies of transcripts / Sila lampirkan salinan transkrip yang telah disahkan *Results / Qualification / Course Keputusan / Kelayakan / Kursus *CGPA / PNGK School / Institution Sekolah /Institusi

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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 Insurance / Insurans Actuarial Science / Sains Aktuari

Matriculation / Foundation Matriculation / Foundation Matriculation / Foundation

Degree

Degree

Degree

Masters

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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