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SCHOLARSHIP AWARD APPLICATION FORM

For Office Use Only: Date Received / Printed: Date of Interview: Discipline: A-Level/Matriculation: [ ] Undergraduate: [ ] Local [ ] Overseas [ ]

Please follow these instructions: 1. Fill only one copy of the application. 2. Attach only the certified true copies of the original certificate 3. Ensure that the form is filled properly and clearly. Any false information will disqualify the application. 4. Fully completed form must be sent to: i) HUMAN RESOURCE DEPARTMENT

SECURITIES COMMISSION 3 PERSIARAN BUKIT KIARA BUKIT KIARA, 50490 KUALA LUMPUR or; ii) [email protected]

Please Affix a Recent Passport Size Photograph

A. PERSONAL PARTICULARS

Name as per NRIC Gender New I/C No. Marital Status : : Male : : [ ] Female [ ] Date of Birth / Age Nationality Religion : : Race : :

Permanent Address (house)

Correspondence Address (mailing) Effective Until: ____________________

Tel No. (House)

: :

(House) (Mobile)

Tel. No. Fax E-mail

: : :

B. PROPOSED FIELD OF STUDY

Courses and universities applied for in accordance of preference. No. 1. 2. 3. Course University

HUMAN RESOURCE DEPARTMENT- MMU

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C. EDUCATIONAL BACKGROUND

Please submit certified true copies of all examination results. Name of School/College/University Secondary Education I Secondary Education II A-Level/STPM/Matriculation(s) Certificate(s) Diploma Course(s) Other Relevant Results (English 1119/TOEFL/IELTS/GMAT/Others) No. 1. 2. 3. 4. Subjects Results START month/year FINISH month/year SRP/PMR Result: SPM Result: Results: Major/Result: Major/CGPA/Class: Qualification Obtained

D. EXTRA CO-CURRICULAR ACTIVITIES (Sports, Clubs, Etc.)

Secondary Education

Tertiary Education/ Current Involvement

E. OTHER RELEVANT INFORMATION

In a separate piece of paper, please write an essay (in your own handwriting) stating past achievements and future career aspiration in relation to the application of this scholarship, i.e. what benefits would you hope to derive in pursuing the proposed field of study and how it can help you in your future contributions to the Securities Commission upon successful completion of this course. Write in not more than 1000 words and make sure you enclosed the essay with this application form.

HUMAN RESOURCE DEPARTMENT- MMU

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F. CONTRACTUAL AGREEMENT

Do you have any other service bond or contractual loan with other organisation? If so, please specify: Type Organisation Loan Amount From Bond Period To

G. FAMILY PARTICULARS

i) Father/Guardian Name Address : : ii) Mother/Guardian Name Address : :

I/C No. Passport No. Citizenship Occupation

: : : : :

I/C No. Passport No. Citizenship Occupation

: : : : :

Name and Address of Employer

Name and Address of Employer

Tel No.

House Mobile Office

Tel No.

House Mobile Office

H. SOURCE OF INCOME

Please submit certified relevant documents i.e. salary slip, pension warrant, etc. wherever applicable Basic Monthly Salary a) Father b) Mother c) Guardian Other Source(s) of Income (please specify) a) b) c) TOTAL RM

HUMAN RESOURCE DEPARTMENT- MMU

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I. DEPENDENTS (INCLUSIVE OF APPLICANT)

Children who are already working and/or married are not considered as dependants No. 1) 2) 3) 4) 5) 6) Name Age School/College/University Amount of scholarship / Organisation (if any)

J. SOURCE OF INFORMATION

How did you know about our scholarship? New Straits Times [ ] Utusan [ ] The STAR [ ] Berita Harian [ ] SC Website [ ] Family [ ] Relatives [ ] Friends [ ] Others (please specify): ________________ ________________ ________________

K. PERSONAL REFERENCES (NON-RELATIVES/NON SC EMPLOYEE)

Name Address : : Name Address : :

Tel No. Fax No. E-mail Relationship

: : : :

Tel No. Fax No. E-mail Relationship

: : : :

L. DECLARATION

I hereby declare that all the information given in this scholarship application form is complete and accurate to the best of my knowledge, and I undertake to be bonded by the Securities Commission upon completion of my studies. Any false information provided will disqualify this application.

Signature : ____________________

HUMAN RESOURCE DEPARTMENT- MMU

Date : _________________

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HUMAN RESOURCE DEPARTMENT- MMU

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