Application Form Scholarship 2012

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PUTRA FOUNDATION FUND
2012
PARTICULARS

Latest
Colour
Passport Size
Photo

A.

APPLICANT

i.

Name

_________________________________________________

ii.

IC No. (New)

_________________________________________________

iii.
Sex
_________________

Male / Female

Race

iv.

Citizenship

v.

Age _______________

vi.

House Tel No.
_______________
Mobile No.
_________________
Permanent address __________________________________________________

vii.

_______________

Religion

_________________

E-mail _________________

__________________________________________________
viii.

B.

Correspondence
__________________________________________________
Address (if different
From above)
__________________________________________________

FAMILY PARTICULARS

Name of Parent(s)
& Siblings

Relationshi
p

Status / Occupation

Monthly
Gross
Income
RM

1

Total Income

C.

PARTICULARS OF ACADEMIC QUALIFICATIONS
(Please submit certified true copies of the relevant certificates)
Year /
Semest
er
SPM

Results (CGPA / Grade)
A

B

C

D

E

School / Institution

G

STPM
Diploma
D.

ACTIVITIES / SPORTS
(Please submit certified true copies of the relevant certificates)
YEAR

POSITION

SOCIETY / CLUB /
ACTIVITIES

YEAR

LEVEL REPRESENTED

SPORTS

YEAR

POSITION / LEVEL

OTHER ACTIVITIES

2

Programmes (Choose ONE only)
(
(

) Diploma in Risk Management
) Diploma in Information Technology

(
(
(

) BA Hons in Business Management 3+0
) BA Hons in Accounting & Finance 3+0
) BSc Hons in Forensic Computing 3+0

I confirm that the above information is correct and true.

Applicant’s Signature

Date

Document Checklist
2 Passport size photographs
Photocopies of applicant’s and both parents’ IC (front & back – 2 copies)
Guarantor’s IC (if required)
Certified true copies of academic certificates & transcripts (SPM, STPM.
etc)
Leaving school certificate/Sijil berhenti sekolah
Both parents’ latest payslip (certified true copy)

3

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