SPONSOR A STUDENT A GADGET

APPLICATION FORM
STUDENT INFORMATION
Name : _____________________________________ Age : _____________________
School : _____________________________________ Std/Form : ________________
Residential Address : _______________________________________________________
________________________________________________________
________________________________________________________

FATHER/GUARDIAN MOTHER/GUARDIAN
Name
NRIC No.
Contact No.
Occupation
Monthly Salary
Other monthly Income

Family Dependents
Name Age
1.
2.
3.
4.
5.
6.
7.
Please name a person whom we can call for verification.
Name : _________________________________________
Contact No. : ____________________________________

Form can be emailed to mhdmhq@gmail.com or whatsapp 016-3392234 / 012-2311049

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This application has been verified and we find that the application is
ACCEPTED
NOT ACCEPTED

Officer 1 Officer 2
Name : ______________________________ Name : __________________________
Dated