Please mail/e-mail this form to the address printed below:

INCEIF, Lorong Universiti A, 59100 Kuala Lumpur, Malaysia.

(Attention Admission & Students Affairs Department)
or Fax : +603-7651 4008 or email at financial.assistance@inceif.org

APPLICATION FORM FOR FINANCIAL ASSISTANCE

Applicants are required to complete all fields in this form. Incomplete application will not be processed.
If you have enquiries or in the need of further clarification regarding the financial assistance, please email to
financial.assistance@inceif.org
This form MUST reach INCEIF before:
11 January 2013 (Application for Jan 2013 semester), 3 June 2013 (Application for June 2013 semester),
23 August 2013 (Application for September 2013 semester).

Please choose the INCEIF programme that you have applied.(Please indicate () in box)
Chartered Islamic Finance Professional
PhD in Islamic Finance

Masters in Islamic Finance

SECTION 1: PERSONAL DETAILS

Name

: _______________________________________________________________

Gender

: ____________________________

Age: ____________________________

Identification Number (IC No.)/Passport No

: _______________________________________________________________

Permanent Address

: _______________________________________________________________
_______________________________________________________________

Mailing Address

: _______________________________________________________________
_______________________________________________________________

Nationality

: _______________________________________________________________

Religion

: _______________________________________________________________

Email Address

: _______________________________________________________________

Contact No.

: _______________________________________________________________

INCEIF Student ID

: _______________________________________________________________

SECTION 2: EDUCATION BACKGROUND

Highest Certificate
Class/CGPA

: _______________________________________________________________
: _______________________________________________________________

SECTION 3: FAMILY BACKGROUND

Total Number of Dependant

: _______________

SECTION 4: WORKING EXPERIENCE (Please indicate () in box)

I am currently
:
Employed
Type of Industry

Islamic Finance
related

Self -employed

Unemployed

Non Islamic
Finance related

Non Financial
related

Please indicate income per month (for non-Malaysians, please convert to USD): _______________________________________
Address of Company
: _______________________________________________________________________
Your email address in the Company
: _______________________________________________________________________
SECTION 5: APPLICATION INFORMATION (Please indicate () in box)
Year : ____________________
January
June

September

SECTION 6: DECLARATION
Signature : ________________________

Date : _______________________

SECTION 7: VERIFICATION (This document can only be considered as VALID for processing of application for Financial Assistance when it has
been officially certified by Notary Public or Commissioner of Oaths.

Name of Notary Public/Commissioner for Oaths:

Date :

Notary Public/Commissioner of Oaths Rubber Stamp &

Signature: