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PERAK NAM HOI ASSOCIATION

N o . 7 5 - 7 7 ( T i n g k ia) t, J a l a nM u s t a p h aA l - B a k r i3, 0 3 0 0l p o h ,P e r a k . T e l / F a x: 0 5 - 2 5 4 0 3 3 6
Facebook: www.facebook.com/nam
hoi perak Email: namhoipk@yahoo.com.sg

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Nam Hoi HigherEducationFundFor Members'ChildrenApplicationForm ForYearzOLs
A. ?frFEln Particulars
of Member

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(English)

Name of member: (Chinese)

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N a m eo f a f f i l i a t ea s s o c i a t i o:n
( l f n o t a m e m b e ro f P e r a kN a m H o i A s s o c i a t i o n )

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B. +iHu\ffiE Particulars
of Applicant
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N a m eo f a p p l i c a n:t ( C h i n e s e )

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Secretary
/ President
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l&,lrt Address:
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C. ^+Fl,gfr UniversityExamination
Results
4!l Year

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N a m eo f U n i v e r s i t y

ltif, Result

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D. AElt)R Particulars
of Family
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Father

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Name
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E n g l i sN
hame

N a t i v eP l a c eI n C h i n a

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Company
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Name

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(lnclusive
of marriedones)
of brothers
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Schooli Company

S l u d e n/t O c c u p a t i o n

Monthly Income

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Enclosed
herebythe followingcertifiedcopyof my documents
for your kind consideration
:
(lnsufficient
documentswill not be entertained)
i) ^.+lI.9fr UniversityResult

E lf Date

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ifi qlh\it ldentityCard

BirthCertificate

of member
+ fr eZ Signature

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of applicant
Signature

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Photostatapplicationform is acceptedbut hasto be choppedand signedby the association's

secretary
or president
of theapplicant.

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UniversityDegreeCourse,Minimum C.G.P.A.of 3.00 points.( Basedon the final resultsof academicyear of

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All applicationsmust reachthis associationon or before 5.8.2015.Lateapplicationwill not be entertained.

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shallbegiven.
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Theboard's
to approve
or rejectanapplication
decision
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t*ti tr n * a ^, # od+ A + if, E at ^ * Y-^tr|g.-@
in Localor Foreign
University.
Opento students
studying

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SpecialIncentivewill be given to studentswho are acceptedto do a universitycourse(Foundation/ Year 1) for

academicVear2OL4/2015.Applicantsmust furnish certifiedphotocopyof the following: Offer letter (Surat
Tawaranmasukke universiti)/Officialreceipt(paymentfor registration).

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(ForofficialUseOnly)

,k& A /fr Date Received:

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Approved/ Not Approved : Reason:
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Signature
o f E x a m i n e r:

ll;t)tEA .}n DateApproved :

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/ Secretary
Signature
of Chairman
6* chop:

Note: Please
usecapital
/ blockletters
forEnglish.
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