2023 SCHOLARSHIP APPLICATION FORM

Borang Permohonan Biasiswa Colour

passport-sized photo

Gambar warna
Please email this completed form to / Sila hantarkan borang yang lengkap kepada: berukuran paspot
E-mail: scholarship@mnrb.com.my
(All information / data obtained shall be assessed, processed, analyzed and stored by the Board of Trustees for the purpose of
scholarship application, in accordance with the Personal Data Protection Act 2010 (PDPA))

A) PERSONAL DETAILS / Keterangan Diri Pemohon

Full Name / Nama Penuh

Permanent Address / Alamat Tetap

Telephone Number (Home) / Nombor Telefon (Rumah) Age / Umur New NRIC / Kad Pengenalan (Baru)

Handphone Number / Nombor Telefon Bimbit E-mail / E-mel

Nationality /Warganegara Race / Bangsa

Malaysia Malay / Melayu Indian / India
Others /Lain-lain Chinese / Cina Others / Lain-Lain

Marital Status / Taraf Perkahwinan

Single / Bujang
Others / Lain-lain Female / Perempuan Male / Lelaki

Physical Disabilities (if any) (eyesight, hearing, speech, etc.):

Kecatatan fizikal (jika ada) (seperti penglihatan, pendengaran, percakapan dll):

B) ACADEMIC QUALIFICATIONS / Kelayakan Akademik

Year/ *Results / Qualification / Course *CGPA / School / Institution
Tahun Keputusan / Kelayakan / Kursus PNGK Sekolah /Institusi
SPM -

STPM

Matrics

Diploma

Degree

Others
*Please enclose certified copies of transcripts / Sila lampirkan salinan transkrip yang telah disahkan

C) EXTRA CO-CURRICULUM ACTIVITIES / SPORTS (Last 2 years only)

Kegiatan Ko-kurikulum / Sukan (2 tahun yang lepas)

Year /Tahun Position / Jawatan Society/Club / Persatuan/Kelab

If the space above is insufficient, please continue a separate sheet of paper / Jika ruang di atas tidak mencukupi, sila sambung
dilampiran yang berasingan

1
D) CURRENT OR PREFERRED FIELD OF STUDY FOR SCHOLARSHIP (Please tick)
(Bidang pengajian yang sedang atau ingin diceburi bagi biasiswa ini. Sila tandakan dibawah)

Insurance / Insurans    Matriculation / Foundation    Degree

Actuarial Science / Sains Aktuari    Matriculation / Foundation    Degree

Information Technology / Teknologi Maklumat    Matriculation / Foundation    Degree

Shariah / Shariah    Matriculation / Foundation    Degree

ACCA / ACCA    Foundation in Accountancy (ACCA FIA)    ACCA

Please enclose a copy of the acceptance letter from relevant institutions / universities, if available. / Sila lampirkan salinan
surat tawaran daripada institusi/universiti, jika ada.

Expected / Actual Expected / Actual

Duration of Study
Date of Commencement of Study Date of Completion of Study
Tempoh Pengajian
Tarikh Jangkaan/Sebenar Permulaan Pengajian Tarikh Jangkaan/Sebenar Tamat Pengajian

E) ESSAY / Esei

Please attach a HANDWRITTEN essay in English, NOT EXCEEDING 500 WORDS, describing reasons for
applying for this scholarship, benefits from the course of study including education and career plans.
Sila lampirkan sebuah esei Bahasa Inggeris, secara BERTULIS dan TIDAK MELEBIHI 500 PERKATAAN menghuraikan sebab-
sebab anda memohon biasiswa ini, faedah yang diperolehi dari bidang yang dipelajari serta rancangan pengajian dan kerjaya.

F) Have you received any offer of scholarship or other forms of financial assistance from other parties?
If YES, please give details.
Adakah anda menerima tawaran biasiswa atau sebarang bantuan kewangan dari pihak lain? Jika YA, sila nyatakan.

G) FAMILY DETAILS / Keterangan Keluarga

Parents / Guardian & Siblings’ Names Relationship Occupation

Nama Ibubapa / penjaga & adik beradik Hubungan Pekerjaan

If the space above is insufficient, please continue a separate sheet of paper / Jika ruang di atas tidak mencukupi, sila sambung
dilampiran yang berasingan.

H) CONNECTIVITY
If you are shortlisted for a virtual interview, are you accessible to internet via computer / laptop/
smartphone?
Sekiranya anda disenarai pendek untuk temuduga maya, adakah anda mempunyai sambungan internet melalui komputer /
komputer riba / telefon pintar?

Yes / Ya
No / Tidak

I) DECLARATION /Deklarasi
I declare and confirm that all information as stated above is true and correct.
Saya mengaku dan mengesahkan bahawa segala keterangan yang diberikan di atas adalah sahih dan benar

SIGNATURE/ Tandatangan DATE/ Tarikh