2015 Scholarship Application Form

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2015 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: 03-20930368 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

Handphone Number / Nombor Telefon Bimbit

Nationality /Warganegara
Malaysia
Others /Lain-lain

New NRIC / Kad Pengenalan (Baru)

E-mail / E-mel

Race / Bangsa
Malay / Melayu
Chinese / Cina

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

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

*Results / Qualification / Course
Keputusan / Kelayakan / Kursus

*CGPA /
PNGK

SPM

-

STPM

-

School / Institution
Sekolah /Institusi

Matrics
Diploma
Degree
Master
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

1

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

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

2

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