Copy Of Mnrb

2009 SCHOLARSHIP APPLICATION FORM Borang Permohonan Biasiswa Please send this completed form to/ Sila hantarkan borang yang lengkap kepada : Colour passport size photo/ Gambar warna berukuran paspot

MNRB Scholarship Fund th 11 Floor, Bangunan Malaysian Re No 17, Lorong Dungun, Damansara Heights 50490 Kuala Lumpur

Tel : 2096 7050 / Fax : 03-2096 7003 / E-mail : [email protected]

a) APPLICANT PERSONAL DETAILS/KETERANGAN DIRI PEMOHON Full Name / Nama Penuh

Permanent Address / Alamat Tetap

Telephone Number (Home) / Nombor Telefon (Rumah)

Age/Umur

Hand-phone Number /Nombor Telefon Bimbit Nationality/Warganegara Malaysia Others/Lain-lain

E-mail Address / Alamat E-mel Race/Bangsa Malay/Melayu Chinese/Cina

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

New NRIC/ Kad Pengenalan (Baru)

Female/Perempuan

Indian/India Others/Lain-Lain

Male/Lelaki

Physical handicapped (if any) (eyesight, hearing, spoken etc.) : Kecatatan fizikal (jika ada) (seperti penglihatan, pendengaran, percakapan dll) :

b) ACADEMIC QUALIFICATION/KELAYAKAN AKADEMIK Year/ Tahun

*Result/Keputusan

*CGPA/ PNGK (for/ untuk Diploma/Matrics)

School / Sekolah Institution/Institusi

SPM STPM Matrics Diploma/ Degree (Course/ Kursus) *Please enclose certified copies of the above/ Sila lampirkan salinan-salinan yang telah disahkan

c) On a separate sheet of paper, write a short handwritten essay in English, not exceeding 500 words, describing reasons for applying the scholarship, benefit from the course of study including education and career plan. Di lampiran yang berasingan, sertakan satu esei Bahasa Inggeris secara bertulis dan tidak melebihi 500 perkataan, sebab-sebab anda memohon biasiswa, keuntungan yang diperolehi dari bidang kursus yang dipelajari serta rancangan pembelajaran dan kerjaya.

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d) Extra Moral Activities / Sports (Last two years only) Kegiatan Kokurikulum / Sukan ( Dua tahun yang lepas)

Year/Tahun

e)

Position/Jawatan

Society/Persatuan

Please enclose a copy of the acceptance letter by the relevant institution/university, if available. Please tick below your current area of study or your preferred area of study Sila lampirkan salinan surat tawaran daripada institusi/universiti yang berkenaan, jika ada. Sila tandakan dibawah bidang pengajian yang sedang anda ikuti atau pilihan bidang pengajian anda.

Matriculation /Matrikulasi

Course/Kursus :

_______________________________

Actuarial Science/Sains Aktuari

Diploma

Degree

Professional

Insurance/Insurans

Diploma

Degree

Professional

Risk Management / Pengurusan Risiko

Diploma

Degree

Professional

Expected/Actual Date of Commencement of Study

Duration of Study Tempoh Pengajian

Tarikh Sebenar/Jangkaan Permulaan Pengajian

f)

Expected/Actual Date of Completion of study Tarikh Sebenar/Jangkaan Tamat Pengajian

Have you received any offer for scholarship or other forms of financial assistance from other If YES, please give details.

bodies ?

Adakah anda menerima tawaran biasiswa atau sebarang bantuan kewangan dari pihak lain? Jika YA, sila nyatakan.

g)

NEXT OF KIN/Keterangan Keluarga Parents or guardian and siblings’ names / Nama Ibubapa atau penjaga serta

Relationship/

Occupation/

Hubungan

Pekerjaan

adik beradik

*Monthly gross

income/ *Pendapatan kasar sebulan

Total Gross Income (RM)/Jumlah Pendapatan Kasar (RM)

*Please enclose a photostat copy of the latest salary slip/Sila lampirkan salinan slip gaji terbaru. 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.

DECLARATION/Pengakuan

I declare and confirm that all information as stated above are true and correct. Saya mengaku dan mengesahkan bahawa segala keterangan-keterangan yang diberikan di atas adalah betul dan benar.

SIGNATURE/ Tandatangan

DATE/ Tarikh

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