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SUPERB Application Form to Participate in the Business Challenge Please complete this form and email it back to [email protected] State your email subject as: SUPERB Application : You can also attach any relevant additional information. The closing date for the 1st round of applications is on 21 February 2014, 5.30pm. Idea Title : Personal Details Team Leader Name Gender Date of Birth MyKad Number Marital Status Number of Children (if any) Language(s) Spoken
: : : : : : :
Education/Qualification
:
Home Address Mobile Number(s) Email
: : :
I am a(n)
Family business background
Previous employer(s)
JIM LUQMAN HAKEMBIN HJ. MOHAMAD MALE 14TH JULY 1981 810714-01-5875 MARRIED 2 MALAY LANGUAGE AND ENGLISH DIPLOMA IN TECH IN ELECTRICAL EQUIPMENT & INSTALLATION TECH, 2002, MALAYSIA FRANCE INSTITUTE. 28-7, JALAN DAMAI, TANJUNG AGAS, 84000 LEDANG, JOHOR DARUL TAK’ZIM. 0166177542 [email protected] Student <which institution and course?> Employee Professional Unemployed Entrepreneur <10 years>
:
:
Jim Haiery B. Mohamad: IT & Engineering Haryaty Murni B. Mohamad: IT & Construction Company. Izaziah Morni B. Mohamad: Automotive Parts. 2002- May 2003(Kenseisha (M) Sdn. Bhd.) Junior Technician Task: AutoCAD Drafter , ISO 9002 Documentation Supervisory Maintainance Department, Machine Troubleshooting, Master & Jig Calobration, 2003-2004 : Direct Selling Business (Elken Sdn. Bhd.) 2003-2004 : Sri Nilam Budi Trading (Supply Coffee powder “KENALI KOPI”) 1
2004 : Techno-preneur MARA (Majlis Amanah Rakyat)Prima Consulting Malaysia Nature of Business : (Engineering Business) Duration : 24 months Attachment with Tracoma Holding Berhad and Teguh Timur Technology Sdn.Bhd. Trachoma Holding Berhad : Marketing task for Progressive Punching Machine and Injection Moulding. Achivement: RFQ for Honda (M) Sdn. Bhd. and Hitachi Aircondition (M) Sdn. Bhd. Teguh Timur Technology Sdn. Bhd. From Waste to Wealth : Palm Oil Empty fruit bunch (EFB) to paper pulp. Business proposal for FELDA & Felcra Berhad. Achievement : Presentation proposal for FELDA Berhad. Status: K.I.V 2006: Pineapple Ark Sdn. Bhd. (Managing Director) Biotech status company Non Disclosure Agreement with Malaysian Institute for Nuclear Technology (Mint @ Malaysia Nuclear Agency) (BioFertiliser with Enhance Microbe) 2007-Present: Marvelous Point (Manager) Supplies computer parts Marketing for Nota Asia Sdn. Bhd.Multimedia Development Corporation (MDeC) Soft skill , Undergraduate Skill Programme.(J2EE) Organised Defensive Riding & Driving Course (Marshall) 2009-2012. Achievement: 20 Series of Marshall Course, Appearances on TV3, TV9 and TV1
2
Personal Details Team Member 1 Name Gender Date of Birth MyKad Number
: : : :
Education/Qualification
:
Home Address Mobile Number(s) Email
: : :
I am a(n)
AHMAD BIN YUNUS MALE 15TH JULY 1966 660715-01-5171 UNDERGRADUATE BUSINESS MANAGEMENT, 1989, MARA INSTITUTE OF TECHNOLOGY No. 24, JALAN MELOR 3, TAMAN KESANG BARU, 84000 LEDANG, JOHOR DARUL TAK’ZIM 019-6282101
Student <which institution and course?> Employee Professional Unemployed Entrepreneur
Family business background
:
Previous employer(s)
:
1989-1993, MASS PRODUCTION ASST. MANAGER IN JAPANESE ELECTRONIC COMPANY, 1995-2008, PRODUCTION PLANNING MANAGER CUM WAREHOUSE & LOGISTIC MANAGER AT HARTA PACKAGING BHD., PUBLIC LISTED COMPANY . Main Duty- Planning, Execute and maintaining company for production lean system, ISO 9002 & 14000, Supervise 3 teams of employees 1. Production Planning, 2. Warehousing, 3. Logistic. 4. 2008 – PRESENT, LEDANG WOODWORKS INDUSTRIES, MANAGER, WOOD PRODUCTS.
3
Team Member 2 Name Gender Date of Birth MyKad Number Education/Qualification Home Address Mobile Number(s) Email
: : : : : : : :
I am a(n)
Student <which institution and course?> Employee Professional Unemployed Entrepreneur
Family business background Previous employer(s)
: :
Company (if already incorporated) Company Name Company Number Company Address Company Shareholders
: : : :
Company Directors
:
Paid-Up Capital (RM) Date of Incorporation Years in Operation Nature of Business Revenue for 2013 Profit after tax for 2013
: : : : : :
Please answer the questions below regarding your idea/product/solution: 1. Tell us your business idea in less than 200 words
4
2. Why do you think it will work? What makes your business unique?
3. Which sector does your business fall into?
Communications, Content & Infrastructure Electronics & Electrical Wholesale & Retail Palm Oil & Rubber Oil, Gas & Energy Financial Services Business Services Healthcare Agriculture Education Tourism Other: <state other sector(s)>
4. Has this idea been pitched or presented to other Government agencies? If yes, which agencies?
5. How much did you invest your own money in this?
6. Tell us your team's experience and capability that makes you capable of delivering this project. Please include relevant past projects. 5
7. Who is your target market?
8. What would be your business model?
9. How much funds do you need and why do you need it? Utilisation of funding
Amount (RM)
TOTAL
6
Declaration Have you received any financial assistance from the Government before? ( Yes / No ) If yes, which Government agency, how much, for what type of project and state utilisation of funds
Please state which information provided in this application that you do not agree to be used for the purposes of consolidation, analysis, preparing statistics, marketing, advertising and promotion via television and/or other mass or social media
I, JIM LUQMAN HAKEM BIN HJ. MOHAMAD 810714-01-5875, hereby declare: 1.
Acknowledgement
a)
I acknowledge that the submission of this application does not create an obligation or guarantee on the part of TERAJU to approve the application herein.
b)
I hereby agree for TERAJU to process my personal data provided herein for the purpose of this application.
c)
I hereby acknowledge that while TERAJU will use reasonable effort to safeguard the confidentiality of the information submitted in this application, TERAJU shall be entitled to: i.
disclose the information submitted herein to such persons involved in the evaluation process of this application including without limitation TERAJU’s employees, consultants, agents, advisors and/or such other persons as may be appointed by TERAJU; and
ii.
use any information submitted herein for the purposes of consolidation, analysis, preparing statistics, marketing, advertising and promotion via television and/or other mass or social media, and if I do not agree that any part of the information provided herein can be used for such purpose, I should expressly identify such data and highlight the same to TERAJU in advance in this application form.
7
d)
I further acknowledge that TERAJU considers all submitted applications as confidential and treats all team matters accordingly. However, TERAJU cannot guarantee complete confidentiality for proprietary matters. TERAJU is not responsible for any proprietary information and/or intellectual property included in a submitted application. Ultimately, I am solely responsible to protect sensitive materials.
2.
True and Accurate
I hereby declare that all information furnished, or to be furnished, in connection with the Project and this application does not contain any untrue statements and were honestly provided and made upon due and careful inquiry and I have not omitted to state any fact(s), the omission of which makes such statements misleading. 3.
Personal Data Protection Statement
I agree that, with regard to the personal data relating to the other individual(s), which are provided to TERAJU in this application form, I have obtained the following from such individual(s): (a)
his/her consent for TERAJU to process his/her personal data provided in this application form, and any other additional personal data which may be further provided to TERAJU in connection with this application form;
(b)
his/her confirmation that his/her personal data provided are complete and accurate;
(c)
his/her acknowledgment that he/she is entitled to obtain access to and to request correction of the personal data provided to TERAJU and that he/she can request TERAJU to cease processing his/her personal data. For this purpose, he/she should contact TERAJU, either by sending an email to [email protected] or by sending a letter to TERAJU at Level 5, Surian Tower No. 1, Jalan PJU 7/3 Mutiara Damansara, 47810 Petaling Jaya, Selangor Darul Ehsan; and
(d)
his/her consent that TERAJU may disclose his/her personal data to: i.
any TERAJU vendor(s), contractor(s) and/or outsourcing company(ies) engaged by TERAJU, for purposes in connection with this application form; and/or
ii.
Government authorities, agencies and and/or any other regulatory body, to the extent that the Government or other authorities, agencies and/or any other regulatory body need to know, or as permitted by applicable laws and regulations.
I further agree that in any event TERAJU receives any request by any data subject for withdrawal of consent to process any personal data provided herein, TERAJU has the right to treat this application as null and void.
8
BY SUBMITTING THIS APPLICATION FORM TO TERAJU, I HEREBY CONFIRM MY DECLARATION, ACKNOWLEDGEMENT AND AGREEMENT ON ALL THE INFORMATION GIVEN AND TERMS STATED ABOVE
9
: : : : : : :
Education/Qualification
:
Home Address Mobile Number(s) Email
: : :
I am a(n)
Family business background
Previous employer(s)
JIM LUQMAN HAKEMBIN HJ. MOHAMAD MALE 14TH JULY 1981 810714-01-5875 MARRIED 2 MALAY LANGUAGE AND ENGLISH DIPLOMA IN TECH IN ELECTRICAL EQUIPMENT & INSTALLATION TECH, 2002, MALAYSIA FRANCE INSTITUTE. 28-7, JALAN DAMAI, TANJUNG AGAS, 84000 LEDANG, JOHOR DARUL TAK’ZIM. 0166177542 [email protected] Student <which institution and course?> Employee Professional Unemployed
:
:
Jim Haiery B. Mohamad: IT & Engineering Haryaty Murni B. Mohamad: IT & Construction Company. Izaziah Morni B. Mohamad: Automotive Parts. 2002- May 2003(Kenseisha (M) Sdn. Bhd.) Junior Technician Task: AutoCAD Drafter , ISO 9002 Documentation Supervisory Maintainance Department, Machine Troubleshooting, Master & Jig Calobration, 2003-2004 : Direct Selling Business (Elken Sdn. Bhd.) 2003-2004 : Sri Nilam Budi Trading (Supply Coffee powder “KENALI KOPI”) 1
2004 : Techno-preneur MARA (Majlis Amanah Rakyat)Prima Consulting Malaysia Nature of Business : (Engineering Business) Duration : 24 months Attachment with Tracoma Holding Berhad and Teguh Timur Technology Sdn.Bhd. Trachoma Holding Berhad : Marketing task for Progressive Punching Machine and Injection Moulding. Achivement: RFQ for Honda (M) Sdn. Bhd. and Hitachi Aircondition (M) Sdn. Bhd. Teguh Timur Technology Sdn. Bhd. From Waste to Wealth : Palm Oil Empty fruit bunch (EFB) to paper pulp. Business proposal for FELDA & Felcra Berhad. Achievement : Presentation proposal for FELDA Berhad. Status: K.I.V 2006: Pineapple Ark Sdn. Bhd. (Managing Director) Biotech status company Non Disclosure Agreement with Malaysian Institute for Nuclear Technology (Mint @ Malaysia Nuclear Agency) (BioFertiliser with Enhance Microbe) 2007-Present: Marvelous Point (Manager) Supplies computer parts Marketing for Nota Asia Sdn. Bhd.Multimedia Development Corporation (MDeC) Soft skill , Undergraduate Skill Programme.(J2EE) Organised Defensive Riding & Driving Course (Marshall) 2009-2012. Achievement: 20 Series of Marshall Course, Appearances on TV3, TV9 and TV1
2
Personal Details Team Member 1 Name Gender Date of Birth MyKad Number
: : : :
Education/Qualification
:
Home Address Mobile Number(s) Email
: : :
I am a(n)
AHMAD BIN YUNUS MALE 15TH JULY 1966 660715-01-5171 UNDERGRADUATE BUSINESS MANAGEMENT, 1989, MARA INSTITUTE OF TECHNOLOGY No. 24, JALAN MELOR 3, TAMAN KESANG BARU, 84000 LEDANG, JOHOR DARUL TAK’ZIM 019-6282101
Student <which institution and course?> Employee Professional Unemployed
Family business background
:
Previous employer(s)
:
3
Team Member 2 Name Gender Date of Birth MyKad Number Education/Qualification Home Address Mobile Number(s) Email
: : : : : : : :
I am a(n)
Student <which institution and course?> Employee Professional Unemployed
Family business background Previous employer(s)
: :
Company (if already incorporated) Company Name Company Number Company Address Company Shareholders
: : : :
Company Directors
:
Paid-Up Capital (RM) Date of Incorporation Years in Operation Nature of Business Revenue for 2013 Profit after tax for 2013
: : : : : :
Please answer the questions below regarding your idea/product/solution: 1. Tell us your business idea in less than 200 words
4
2. Why do you think it will work? What makes your business unique?
3. Which sector does your business fall into?
Communications, Content & Infrastructure Electronics & Electrical Wholesale & Retail Palm Oil & Rubber Oil, Gas & Energy Financial Services Business Services Healthcare Agriculture Education Tourism Other: <state other sector(s)>
4. Has this idea been pitched or presented to other Government agencies? If yes, which agencies?
5. How much did you invest your own money in this?
6. Tell us your team's experience and capability that makes you capable of delivering this project. Please include relevant past projects. 5
7. Who is your target market?
8. What would be your business model?
9. How much funds do you need and why do you need it? Utilisation of funding
Amount (RM)
TOTAL
6
Declaration Have you received any financial assistance from the Government before? ( Yes / No ) If yes, which Government agency, how much, for what type of project and state utilisation of funds
Please state which information provided in this application that you do not agree to be used for the purposes of consolidation, analysis, preparing statistics, marketing, advertising and promotion via television and/or other mass or social media
I, JIM LUQMAN HAKEM BIN HJ. MOHAMAD 810714-01-5875, hereby declare: 1.
Acknowledgement
a)
I acknowledge that the submission of this application does not create an obligation or guarantee on the part of TERAJU to approve the application herein.
b)
I hereby agree for TERAJU to process my personal data provided herein for the purpose of this application.
c)
I hereby acknowledge that while TERAJU will use reasonable effort to safeguard the confidentiality of the information submitted in this application, TERAJU shall be entitled to: i.
disclose the information submitted herein to such persons involved in the evaluation process of this application including without limitation TERAJU’s employees, consultants, agents, advisors and/or such other persons as may be appointed by TERAJU; and
ii.
use any information submitted herein for the purposes of consolidation, analysis, preparing statistics, marketing, advertising and promotion via television and/or other mass or social media, and if I do not agree that any part of the information provided herein can be used for such purpose, I should expressly identify such data and highlight the same to TERAJU in advance in this application form.
7
d)
I further acknowledge that TERAJU considers all submitted applications as confidential and treats all team matters accordingly. However, TERAJU cannot guarantee complete confidentiality for proprietary matters. TERAJU is not responsible for any proprietary information and/or intellectual property included in a submitted application. Ultimately, I am solely responsible to protect sensitive materials.
2.
True and Accurate
I hereby declare that all information furnished, or to be furnished, in connection with the Project and this application does not contain any untrue statements and were honestly provided and made upon due and careful inquiry and I have not omitted to state any fact(s), the omission of which makes such statements misleading. 3.
Personal Data Protection Statement
I agree that, with regard to the personal data relating to the other individual(s), which are provided to TERAJU in this application form, I have obtained the following from such individual(s): (a)
his/her consent for TERAJU to process his/her personal data provided in this application form, and any other additional personal data which may be further provided to TERAJU in connection with this application form;
(b)
his/her confirmation that his/her personal data provided are complete and accurate;
(c)
his/her acknowledgment that he/she is entitled to obtain access to and to request correction of the personal data provided to TERAJU and that he/she can request TERAJU to cease processing his/her personal data. For this purpose, he/she should contact TERAJU, either by sending an email to [email protected] or by sending a letter to TERAJU at Level 5, Surian Tower No. 1, Jalan PJU 7/3 Mutiara Damansara, 47810 Petaling Jaya, Selangor Darul Ehsan; and
(d)
his/her consent that TERAJU may disclose his/her personal data to: i.
any TERAJU vendor(s), contractor(s) and/or outsourcing company(ies) engaged by TERAJU, for purposes in connection with this application form; and/or
ii.
Government authorities, agencies and and/or any other regulatory body, to the extent that the Government or other authorities, agencies and/or any other regulatory body need to know, or as permitted by applicable laws and regulations.
I further agree that in any event TERAJU receives any request by any data subject for withdrawal of consent to process any personal data provided herein, TERAJU has the right to treat this application as null and void.
8
BY SUBMITTING THIS APPLICATION FORM TO TERAJU, I HEREBY CONFIRM MY DECLARATION, ACKNOWLEDGEMENT AND AGREEMENT ON ALL THE INFORMATION GIVEN AND TERMS STATED ABOVE
9
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