APPLICATION PROCEDURES

1. Complete the Tzu Chi Scholarship Application Form in BLOCK LETTERS using BLACK INK only;
2. Any corrections should be initialled. DO NOT use any correction fluid / eraser;
3. Documents to be submitted MUST be *Certified True Copies and arranged in the sequence stated below.
Please DO NOT STAPLE but use clips instead.
4. Photocopied documents are to be in A4 size;
5. The Foundation reserves the right to REJECT any incomplete application.

Please tick where documents are attached:-

Original & Complete Tzu Chi Scholarship Application Form 1 copy

Applicant’s Identity Card 1 copy
1st Guarantor’s Identity Card 1 copy
2nd Guarantor’s Identity Card 1 copy
Letter of offer for admission from approved institution (if any) 1 copy
Applicant’s SPM/STPM/SM3/UEC/Diploma or other highest academic 1 copy
qualification’ certificates
Applicant’s school leaving certificate 1 copy
Applicant’s latest semester examination results in university/college (if 1 copy
available)
1st guarantor’s latest (1 year) income tax’s Borang “B” or “BE” with tax receipt 1 copy
or latest EA Form or EPF Statement or last 3 months’ pay slips (any ONE, if
available)
2nd guarantor’s latest (1 year) income tax’s Borang “B” or “BE” with tax receipt 1 copy
or latest EA Form or EPF Statement or last 3 months’ pay slips (any ONE, if
available)
Applicant’s recent passport-sized photograph 1 copy

Declaration by Applicant (Form) 1 copy

Declaration by Guarantor (Form) 1 copy

*DOCUMENTS MAY BE CERTIFIED BY:

Advocate & Solicitor, Commissioner for Oaths, Dean/Registrar of University/ College, Member of
Parliament, Member of State Legislative Assembly, Justice of Peace, School Headmaster/Principal,
Municipal Counselor, District Counselor or such person as may be acceptable to the Board.

(ALL CERTIFIED DOCUMENTS MUST BE AFFIXED WITH AN OFFICIAL CHOP)

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 YAYASAN PENDIDIKAN TZU-CHI MALAYSIA
(Reg. No. 1201502-D)

SCHOLARSHIP FOR EARLY CHILDHOOD EDUCATION STUDIES Application Form

Please complete in CAPITAL LETTERS using BLACK INK ONLY Please affix passport-sized

Tick √ the appropriate items photograph here

ENROLLED PROGRAM (DIPLOMA/ DEGREE) & INSTITUTION

Course Institution

SECTION 1 PERSONAL PARTICULARS

Name (As per IC) 中文名字

New NRIC No. Old NRIC No.

- -

Date of birth (DD/MM/YYYY): / /

Gender: Male Female
Race: Malay Chinese Indian Others

Nationality: Religion:

Permanent Address (Must be a Malaysian address)

Postcode State
___________________

Mailing Address Same As Above (Must be a Malaysian address)

Postcode State
___________________

Tel: Fax:
- -

H/P: E-mail Address:

0 1 - _______________________________________________

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SECTION 2 EXTRACURRICULAR ACTIVITIES (Last 2 years only)
Year Position Held (eg. President/Working Committee) Society/Association Institution

Year Level represented (eg. Country/State/District/School) Sports Activity Institution

Year Level represented (eg. Country/State/District/School) Awards/Commendations Institution

SECTION 3 EDUCATION
Level Name of School/Institution Grade Obtained Completion Year
SPM/O-Level or A B C D OTHERS
Equivalent
Foundation/STPM/A- CGPA:
Level or equivalent

SECTION 4 PERSONAL INTRODUCTION

【請以中文（不少過 500 字）撰寫個人自傳】
Please list any information that you wish to bring to the attention of the Scholarship Selection Committee

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SECTION 5 TZU-CHI ACTIVITIES PARTICIPATION/INVOLVEMENT
Year Name of Activity Participant/Volunteer Activity Location/Venue
Participant/Volunteer
Participant/Volunteer
Participant/Volunteer
Participant/Volunteer
Participant/Volunteer
Participant/Volunteer
Participant/Volunteer

SECTION 6 FAMILY PARTICULARS

Please insert details of all immediate family members, including sibling(s) and guardian(s). Any deceased members can be notified
as “DECEASED” in the Occupation column.

Full Name NRIC Relationship Occupation Monthly Gross Income

Father
Mother

Please list if you have relatives working with the Taiwan Buddhist Tzu-Chi Foundation Malaysia
Name of Relative Staff No Relationship Branch/Department

SECTION 7 MONETARY AID FROM OTHER ORGANIZATIONS

Organization Amount Form of Assistance Period of Aid (yyyy to yyyy)
(Scholarship/Loan)

SECTION 8 PARTICULARS OF GUARANTORS

1st Guarantor’s Particulars

Name (As per IC) 中文名字

New NRIC No.

- -

Permanent Address (Must be a Malaysian address)

Postcode State
___________________

Mailing Address Same As Above (Must be a Malaysian address)

Postcode State ___________________

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House Tel:
-

H/P:
0 1 -

Fax:
-

E-mail Address:
_______________________________________________

Marital Status: ____________________ Sex: _____________ Race: _______________

Employment Status: Self Employed / Under Employment

Name of the Employer/ Company

Position: ____________________ Years of Service: _______ Email address: _____________________________

Gross Monthly Income: RM___________________ Relationship with Applicant: ___________________

2nd Guarantor’s Particulars

Name (As per IC) 中文名字

New NRIC No.

- -

Permanent Address (Must be a Malaysian address)

Postcode State
___________________

Mailing Address Same As Above (Must be a Malaysian address)

Postcode State
___________________

House Tel:
-

H/P:
0 1 -

Fax:
-

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E-mail Address:
_______________________________________________

Marital Status: ____________________ Sex: _____________ Race: _______________

Employment Status: Self Employed / Under Employment

Name of the Employer/ Company

Position: ____________________ Years of Service: _______ Email address: _____________________________

Gross Monthly Income: RM___________________ Relationship with Applicant: ___________________

SECTION 9 APPLICANT’S DECLARATION

Do you or any of your family members suffer/have suffered from any medical condition (mental or physical) which requires regular
or prolonged medical treatment?
Yes No

If Yes, please give full details: _____________________________________________________________________________

I hereby declare that the above information provided in this form is true and correct. I hereby authorize and consent to Yayasan
Pendidikan Tzu Chi Malaysia to obtain if necessary, official records directly from any education institution(s) that I have attended. I
understand that any provision of inaccurate or false information or omission of information will render this application invalid and
that, if admitted on the basis of such information, I can be required to withdraw and/or indemnify the Yayasan in full.

__________________
Signature of Applicant
Date:

SECTION 10 REFERENCE(S)
You are required to provide TWO reference letters for this application, ONE of whom MUST be a Tzu-Chi volunteer.
Referee 1 Referee 2
Name
NRIC Number
Contact Number
Address

Tzu-Chi’s Identity

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DOCUMENT CHECKLIST
Applicant must attach the following documents in the specific order:-
Copy of SPM Trial Exam Result/Actual Result
Copy of School Leaving Certificate
Copy of Applicant’s NRIC (Front and Back)
Copy of Parents/Guardian’s Payslip or Parents’ Income Declaration Form
Copy of Parents/Guardian’s Income Tax Statement (EA Form or J Form)
Copy of Enrolment Letter from respective College/ University (if any)
Copy of 1st Guarantors’ NRIC (Front and Back)
Copy of 1st guarantor’s latest (1 year) income tax’s Borang “B” or “BE” with tax receipt or latest EA Form or EPF
Statement or last 3 months’ pay slips (any ONE, if available)
Copy of 2nd Guarantors’ NRIC (Front and Back)
Copy of 2nd Guarantor’s latest (1 year) income tax’s Borang “B” or “BE” with tax receipt or latest EA Form or EPF
Statement or last 3 months’ pay slips (any ONE, if available)
1st Reference Letter
2nd Reference Letter
Declaration by Applicant (Form)
Declaration by Guarantor (Form)

All the above documents must be certified true copy by either of the followings:-

1. Government School Principal

2. Village Head or Community Leader
3. Civil Servant from the Management & Professional Grade
4. Administrative Officer of Taiwan Buddhist Tzu-Chi Foundation Malaysia/ Yayasan Pendidikan Tzu-Chi Malaysia

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 PRIVACY NOTICE TO TZU-CHI SCHOLARSHIP APPLICANT
In view of the Personal Data Protection Act 2010 (“PDPA”), you have the right to know the purpose for which for your personal data
is collected and the manner in which your personal data may be disclosed by us. Furthermore, you have the right to access your
personal data which is kept by us and may make correction or update your personal data or limit the processing of your personal data
by us.

In this notice, we wish to inform you of the manner in which your personal data is being processed by us.

By providing your personal data to us, you are consenting to the terms and conditions of this Privacy Notice and the collection, use,
access, transfer, storage and processing your personal data as described in this Privacy Notice. If you do not wish to give us this
consent, kindly notify us in writing. Failure to consent to the terms and conditions of this Privacy Notice will result in us being unable
to process your application, request and/ or provide you with the relevant services and/ or loan facility.

Our personal data records contain the following data on you, including but not limited to:-

 Personal details: name, old IC number, NRIC number, date of birth, gender, application/loan number, nationality, race,
photograph, marital status, number of dependents, permanent address, residential address, contact number(s), number of siblings,
nosiness information, occupation, income information, financial information, financial commitment information, bank
statement(s), credit card information and statement(s), education background, academic qualifications and achievements, and
employment information and employment history;
 Family members and/or business partners details: name(s), old IC number, NRIC number, age, residential address, contact
number(s), academic qualifications, and employment information and employment history;
 Applicant’s details: name(s), old IC number, NRIC number, age, residential address, contact number(s), education background,
academic qualifications and achievements, financial commitment information, and employment information and employment
history;
 Guarantor details: name(s), old IC number, NRIC number, permanent address, residential address, contact number(s), business
information, occupation, income information, financial information, financial commitment information, academic qualifications,
employment background, and employment information.

Our personal data records may also contain your sensitive personal data such as information as to your physical or mental health or
condition, political opinions, religious beliefs or similar nature, and the commission or alleged commission of any offence.

Your personal data also includes any other personal information which may be supplied to us from time to time.

These data have been obtained via interviews conducted with you; your application form and other related forms which we have
provided either in hard copies or in electronic format on Tzu Chi website (http://www.tzuchi.my) and from cookies through the use
of Tzu-Chi website; and documents furnished by you to us.

The provision of your personal data to us is voluntary. However, if you do not provide your personal data to us, we may not be able
to provide you services and/ or loan facility which you require and may not be able to communicate with you.

We shall process your personal data for the following purposes:

 To process and/or approve your loan application or other services required by you and other purposes incidental thereto;
 To communicate with you;
 Internal record keeping and facilitating processes of our scholarship/ loan database, services and loan facilities and other related
internal processes and activities;
 To provide you with marketing information on our scholarship/ loan or other services;
 For internal administrative purpose including but not limited to internal audit, corporate governance, statistical analysis, market
survey and trend analysis;
 To provide information to regulatory and governmental authorities in order to comply with statutory and government
requirements; and

Other relevant and related purposes which we deem necessary.

Who has access to your personal data?

Kindly note that your personal data is used, stored, disclosed, transferred and processed by us, our related foundation, appointed
consultants, professional advisors (Including lawyers, accountants, auditors, insurers, etc.) and other relevant authorities (inclusive
of Governmental Agencies and Ministries) for the purposes described above.

In the event that the transfer of your personal data outside of Malaysia is rendered necessary for the purposes stated above, the transfer
of data will be done in accordance to the requirements of the PDPA and you are deemed to have consented to the said data transfer.

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Your rights to the personal data

Under the PDPA, you are entitled to request access to, correct your personal data, make inquiries or complaints about your personal
data and limit the manner in which your personal data is processed by contacting us as follows:

MS Ng Kah Shan
Taiwan Buddhist Tzu-Chi Foundation Malaysia
KL Tzu-Chi Jing Si Hall
Lot 359, Jalan Kepong,
52000 Kuala Lumpur.

Email address: ksng@tzuchi.edu.my

Telephone Number: 03-62563820

You may notify us in writing is you do not wish to receive any marketing materials from us and we shall immediately remove you
from our marketing contact list.

We recommend that requests for access to your personal data be in writing. We may also require you to provide us with additional
information reasonably required to process your request.

Please note that under the PDPA. We have the right to refuse your requests to access or correct your personal data for certain reasons
permitted under the PDPA. Also, we have the right to charge an administrative fee for responding to your requests.

Your obligations regarding your personal data

You are responsible for informing us about changes to your personal data and for ensuring that such information is accurate, up-to-
data and complete.

In the event that you need to provide us with personal data relating to the third parties (for example your family members’ personal
details), you confirm that you have (i) obtained their consent or otherwise entitled to provide their personal data to us and for us to
use accordingly, and (ii) informed them to read this Privacy Notice at Tzu Chi Website.

Our commitment

We have a firm commitment to keeping your personal data secure and confidential at all times. We protect your personal data by
maintaining strict physical and electronic safeguards to prevent any unauthorized access to your data.

As we operate in a dynamic and ever changing environment, we reserve the right to amend this notice from time to time to suit our
contextual requirements and to best protect your personal data.

If your application is unsuccessful, we will keep your information for a reasonable period in accordance with legal requirements and
for administration purposes.

Please feel free to contact us if you require further clarification on this Privacy Notice.

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 DECLARATION BY APPLICANT 申請者聲明事項

I hereby declare that:

1. Pursuant to the Credit Reporting Agencies Act 2010 (“the Act”), I/We, whether as Individual or as
Directors/Shareholders/Business Interest Parties do hereby give consent to and authorise YAYASAN
PENDIDIKAN TZU-CHI MALAYSIA (hereinafter referred to as “the Foundation”) to obtain and/or disclose
any Credit Information (as defined in the Act) relating to me/our company from and/or to any party or any
agency that the Foundation deems fit including but are not limited to RMCI, CCRIS, CTOS, CBM or from any
source deemed appropriate and/or by whatever means that the Foundation deems appropriate to verify my/our
credit history or information furnished by me/us and/or the guarantor(s). Further, I/We do hereby give consent
to RAMCI, CCRIS, CTOS, CBM or any source deemed appropriate to disclose any Credit Information (as
defined in the Act) relating to me/ our company from and/or to the Foundation.

根據《2020 信用報告機構法案》，本人/我們，不論以個人身份或董事/持股人/商業合作夥伴在此同
意並授權馬來西亞慈濟教育基金會（以下簡稱基金會）於必要時從/向各有關機構，包括不局限與
RAMCI, CCRIS, CTOS, CBM 及其餘合適單位獲取及/或披露本人/我們公司有關的任何信貸資料，以驗
證本人/我們及/或擔保人所提供的信貸背景及資料。同時，本人/我們也同意 RAMCI, CCRIS, CTOS,
CBM 或其餘合適單位向基金會披露任何有關本人/我們的公司的任何信貸資料。

2. I agree that the Foundation and scholarship/loan approving committee shall not for any reason be liable for any
claim, damage or liability howsoever arising (including indirect, special, consequential or punitive damages or
any monetary loss) to me/us due to the inaccuracy, incompleteness, or inauthenticity of its contents or for the
consequences of reliance which may be placed on the information. I understand that the Foundation reserves
the right to forfeit my eligibility for a scholarship/loan or revoke any scholarship/loan approval granted to me
or recall any scholarship/loan to me under the Scheme in the event that:-

本人同意及接受，馬來西亞慈濟教育基金會若有或從上述有關機構獲得資料，基於其內容有失準確
性或錯誤而影響本人的獎學金/貸款申請， 馬來西亞慈濟教育基金會或其篩選委員或職員無需承擔任
何法律後果或作出任何形式的金錢賠償。本人了解馬來西亞慈濟教育基金會有權於下列情況下取消
本人之獎學金/貸款或取消所批准之貸款或終止並追討在此計劃下所獲得的獎學金/貸款：-

a) Any of the information or documents is found to have falsified or withheld; and/or

若有任何資料或文件被發現虛假或隱瞞； 及/或

b) I am found to have submitted multiple applications or to have previously been granted a scholarship/loan
under the Foundation in respect of this student;
若本人被發現為此指定子女提呈多份獎學金/貸款申請書或在較早時已經在馬來西亞慈濟教育基
金會下獲得獎學金/貸款而有關貸款尚未還清；

3. I have never been made a bankrupt.

本人不是報窮者；

4. I understand that the Foundation has the absolute discretion to approve and reject my application and I shall
accept the Selection Committee’s decision on my application.
本人了解馬來西亞慈濟教育基金會有絕對權力批准或拒絕本人的獎學金/貸款申請，同時也接受篩選
委員會對本人的獎學金/貸款申請所作之決定；

5. The Foundation will not be held responsible for any loss or delay in mail pertaining to my application.
馬來西亞慈濟教育基金會無需對本人之申請書因郵失或郵誤負責；

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 6. I have read the Privacy Notice of YAYASAN PENDIDIKAN TZU-CHI MALAYSIA which may be found in
the website of TAIWAN BUDDHIST TZU-CHI FOUNDATION MALAYSIA( www.tzuchi.my) and consent
to the terms and conditions therein.
本人已閱讀在台灣佛教慈濟基金會馬來西亞網站上的馬來西亞慈濟教育基金會隱私通知書，並同意
與接受其條款與規定。

_____________________________________ ______________________________

Signature of Applicant Date:

申請人簽名 日期：

Name 姓名 ____________________________

IC NO 身份證號碼 ______________________

NOTE: The above declaration contained both English and Chinese version. If there is any discrepancy between two
versions, the English version shall prevail.

注：以上聲明事項包含英語與華語版本。如有任何差異，準確內容應以英文版本為準。

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 DECLARATION BY GUARANTOR 擔保人聲明事項

Pursuant to the Credit Reporting Agencies Act 2010 (“the Act”), I/We, whether as Individual or as
Directors/Shareholders/Business Interest Parties do hereby give consent to and authorise YAYASAN PENDIDIKAN
TZU-CHI MALAYSIA (hereinafter referred to as “the Foundation”) to obtain and/or disclose any Credit Information
(as defined in the Act) relating to me/our company from and/or to any party or any agency that the Foundation deems
fit including but ate not limited to RMCI, CCRIS, CTOS, CBM or from any source deemed appropriate and/or by
whatever means that the Foundation deems appropriate to verify my/our credit history or information furnished by
me/us and/or the guarantor(s). Further, I/We do hereby give consent to RAMCI, CCRIS, CTOS, CBM or any source
deemed appropriate to disclose any Credit Information (as defined in the Act) relating to me/ our company from and/or
to the Foundation.

I agree that the Foundation and scholarship/loan approving committee shall not for any reason be liable for any claim,
damage or liability howsoever arising (including indirect, special, consequential or punitive damages or any monetary
loss) to me/us due to the inaccuracy, incompleteness, or inauthenticity of its contents or for the consequences of reliance
which may be placed on the information. Further, I/We hereby acknowledge that I/We have read the Privacy Notice of
YAYASAN PENDIDIKAN TZU-CHI MALAYSIA which may be found in the website of TAIWAN BUDDHIST
TZU-CHI FOUNDATION MALAYSIA( www.tzuchi.my) and consent to the terms and conditions therein.

根據《2020 信用報告機構法案》，本人/我們，不論以個人身份或董事/持股人/商業合作夥伴在此同意並授
權馬來西亞慈濟教育基金會（以下簡稱基金會）於必要時從/向各有關機構，包括不局限與 RAMCI, CCRIS,
CTOS, CBM 及其餘合適單位獲取及/或披露本人/我們公司有關的任何信貸資料，以驗證本人/我們及/或擔保
人所提供的信貸背景及資料。同時，本人/我們也同意 RAMCI, CCRIS, CTOS, CBM 或其餘合適單位向基金會披
露任何有關本人/我們的公司的任何信貸資料。

本人同意及接受，馬來西亞慈濟教育基金會若有或從上述有關機構獲得資料，基於其內容有失準確性或錯誤
而影響本人的獎學金/貸款申請， 台灣佛教慈濟基金會馬來西亞或其篩選委員或職員無需承擔任何法律後果
或作出任何形式的金錢賠償。此外，本人也確認本人已閱讀在台灣佛教慈濟基金會馬來西亞網站上的馬來西
亞慈濟教育基金會隱私通知書，並同意與接受其條款與規定。

_____________________________________ ______________________________

Signature of 1st Guarantor Signature of 2nd Guarantor

第一擔保人簽名 第二擔保人簽名

Name 姓名 ____________________________ Name 姓名 __________________________

NRIC NO 身份證號碼 ____________________ NRIC NO 身份證號碼 __________________

Date 日期 _______________________________ Date 日期 ______________________________

NOTE: The above declaration contained both English and Chinese version. If there is any discrepancy between two
versions, the English version shall prevail.

注：以上聲明事項包含英語與華語版本。如有任何差異，準確內容應以英文版本為準。

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