kuok foundation

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KUOK FOUNDATION BERHAD (9641-T) Tingkat 14 Wisma Jerneh, 38 Jalan Sultan Ismail, 50250 Kuala Lumpur T el: 03 - 2142 5319 E-mail: [email protected] Website: www .kuokfoundation.com Borang permohonan untuk bantuan kewangan pelajaran  Application form for educationa l assistance FOR OFFICE USE ONLY RECEIVED: REF. NO.: REMARKS: A MAKLUMA T PEMOHON / PAR TICULARS OF APPLICANT Gambar TERBARU Pemohon RECENT Photograph of Applicant ARAHAN INSTRUCTIONS Taip atau tulis dengan jelas. Gunakan HURUF BESAR. Please type or write clearly. Please use BLOCK LETTERS. Salinan dokumen yang berkaitan yang telah disahkan meslah dilampirkan. (Sila rujuk Syara t Permohonan yang dilampirkan). Cered copies of relevant documents must be aached. (Please see Condions and Procedures for Applicaon aached). Taip atau tulis nama penuh anda sepermana yang terdapat dalam kad pengenalan anda. Gariskan nama keluarga anda. Type or write your name in full as it appears in your NRIC and underline your surname. Sekiranya ruang menulis dak mencukupi, gunakan kertas tambahan dan lampirkan bersama borang permohonan. If space is insucient, please connue in a separate sheet and aach the sheet to the applicaon form. T arikh tutup permohonan: Closing date for applicaon: Nama pemohon seperti kad pengenalan Name of applicant as in NRIC No. kad pengenalan NRIC number Taraf perkahwinan Marital status Alamat rumah (Tetap) Home address (Permanent) No. telefon rumah Home telephone no. No. telefon bimbit Handphone no. Alamat e-mail E-mail address Alamat surat-menyurat Postal address Tarikh dan tempat lahir Date and place of birth Umur  Age Kewarganegaraan Citizenship Bangsa Race Menuntut sepenuh masa Studying full-time Bekerja tetap Full-time employment Bekerja sementara Part-time employment Kedudukan sekarang pada masa pemohonan Present status at time of application Poskod Postal code Poskod Postal code Bandar dan Negeri City and State Bandar dan Negeri City and State Lelaki Male Perempuan Female

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8/6/2019 Kuok Foundation

http://slidepdf.com/reader/full/kuok-foundation 1/6

KUOK FOUNDATION BERHAD(9641-T)

Tingkat 14 Wisma Jerneh, 38 Jalan Sultan Ismail, 50250 Kuala Lumpur 

Tel: 03 - 2142 5319 E-mail: [email protected] Website: www.kuokfoundation.com

Borang permohonan untuk bantuan kewangan pelajaran

 Application form for educational assistance

FOR OFFICE USE ONLY

RECEIVED: REF. NO.:

REMARKS:

A MAKLUMAT PEMOHON / PARTICULARS OF APPLICANT

Gambar TERBARU Pemohon

RECENT Photograph

of Applicant 

ARAHAN

INSTRUCTIONS

Taip atau tulis dengan jelas. Gunakan HURUF BESAR.

Please type or write clearly. Please use BLOCK LETTERS.

Salinan dokumen yang berkaitan yang telah disahkan meslah dilampirkan.

(Sila rujuk Syarat Permohonan yang dilampirkan).

Cerfied copies of relevant documents must be aached.

(Please see Condions and Procedures for Applicaon aached).

Taip atau tulis nama penuh anda sepermana yang terdapat dalam kad pengenalan anda.

Gariskan nama keluarga anda.

Type or write your name in full as it appears in your NRIC and underline your surname.

Sekiranya ruang menulis dak mencukupi, gunakan kertas tambahan dan lampirkan bersama

borang permohonan.

If space is insufficient, please connue in a separate sheet and aach the sheet to the applicaon form.

Tarikh tutup permohonan:Closing date for applicaon:

Nama pemohon seperti kad pengenalanName of applicant as in NRIC 

No. kad pengenalan

NRIC number 

Taraf perkahwinan

Marital status

Alamat rumah (Tetap)

Home address (Permanent)

No. telefon rumah

Home telephone no.No. telefon bimbit

Handphone no.Alamat e-mail

E-mail address

Alamat surat-menyurat

Postal address

Tarikh dan tempat lahir Date and place of birth

Umur 

 Age

Kewarganegaraan

Citizenship

Bangsa

Race

Menuntut sepenuh masa

Studying full-time

Bekerja tetap

Full-time employment 

Bekerja sementara

Part-time employment 

Kedudukan sekarang pada masa pemohonan

Present status at time of application

Poskod

Postal code

Poskod

Postal code

Bandar dan Negeri

City and StateBandar dan Negeri

City and State

Lelaki

Male

PerempuanFemale

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B BUTIR-BUTIR KURSUS / COURSE DETAILS

Yuran kursus

Tuition fees

Yuran lain

Other fees

Tempat tinggal

 Accomodation

Makanan

Food Perbelanjaan lain

Other expenditure

Jumlah

Total 

Bilangan tahun bantuan diperlukan

No. of years assistance required 

Sumbangan setahun daripada keluarga / sumber lain. Nyatakan sumber 

 Amount per annum which can be obtained from family / other sources. State sourcesJumlah bantuan dipohon setahun

 Amount applied for per annum

Kursus dipohon (pilihan pertama) / Sedang dituntut

Course applied (first choice) / Attending 

Nama institusi

Name of institution

Lokasi institusi

Location of institution

Jangkamasa kursus

Duration of course

Mula kursus

Commencement of course (mm/yyyy)

Tamat kursus

Completion of course (mm/yyyy)

Butir - butir perbelanjaan diperlukan setahun (nyatakan dalam Ringgit Malaysia)Breakdown of estimated expenses required per annum (in Malaysian Ringgit)

C MAKLUMAT KELUARGA / INFORMATION ON FAMILY

Butir - butir SEMUA adik-beradik (kecuali pemohon)

Particulars of ALL brothers and sisters (exclude applicant)

Nama

Name

Jantina

Gender 

Umur 

 Age

Taraf 

perkahwinan

Marital status

Bil. anak

(jika ada)

No. of 

children(if any)

Pekerjaan (jika menuntut, nyatakan

peringkat pendidikan dan nama

sekolah / institusi) 

Occupation (If studying, state level of education and name of school / institution)

No. telefon (rumah,

bimbit atau pejabat)

Telephone no.

(home, handphoneor office)

Pendapatan

kasar sebulan

Gross monthly 

income

Kerja sepenuh masa

Full-time employment 

Kerja separuh masa

Part-time employment 

Perniagaan sendiri

Own business

Bersara

Retired 

Nama bapa / penjaga

Father / Guardian’s name

Nama ibu

Mother’s name

No. kad pengenalan

NRIC number 

Umur 

 Age

No. kad pengenalan

NRIC number Umur 

 Age

Alamat

 Address

No. telefon rumah

Home telephone no.

No. telefon bimbit

Handphone no.

Poskod

Postal codeBandar dan Negeri

City and State

Kerja sepenuh masa

Full-time employment 

Kerja separuh masa

Part-time employment 

Perniagaan sendiri

Own business

Bersara

Retired 

Nama dan alamat majikan / perniagaan sendiri. Jika sudah bersara, nyatakan nama dan

alamat majikan / perniagaan sendiri yang terdahulu.

Name and address of employer / own business. If retired, state name and address of  previous employer / own business.

Nama dan alamat majikan / perniagaan sendiri. Jika sudah bersara, nyatakan nama dan

alamat majikan / perniagaan sendiri yang terdahulu.

Name and address of employer / own business. If retired, state name and address of  previous employer / own business.

PekerjaanOccupation

Pendapatan kasar sebulanGross monthly income

Alamat

 Address

PoskodPostal code

Bandar dan Negeri

City and State

No. telefon rumah

Home telephone no.No. telefon bimbitHandphone no.

Pekerjaan

Occupation

Pendapatan kasar sebulan

Gross monthly income

No. telefon pejabatOffice telephone no.

No. telefon pejabatOffice telephone no.

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D MAKLUMAT PENDIDIKAN / INFORMATION ON EDUCATION

E KEPUTUSAN PEPERIKSAAN / EXAMINATION RESULTS

F PENCAPAIAN KO-KURIKULUM / CO-CURRICULAR ACHIEVEMENTS

Butir-butir sekolah pemohon pernah belajar 

Details of schools previously attended by applicant 

Nama sekolah

School nameBandar dan Negeri

City and State

Tahun mula

Year commenced Tahun tamat

Year completed 

Keputusan yang dicapai

Qualifications obtained 

Mata pelajaran

Subject 

SPM /SPVM / ‘O’ level atau kelayakan yang setaraf dengannya

SPM / SPVM / ‘O’ level or equivalent 

Mata pelajaran

Subject 

Gred

Grade

Tahun

Year 

STPM / ‘A’ level / Matrikulasi atau kelayakan yang setaraf dengannya

STPM / ‘A’ level / Matriculation or equivalent 

Gred

Grade

Tahun

Year 

Keputusan peperiksaan universiti / kolej / politeknik seperti gred keseluruhan / purata nilai gred kumulatif, jika ada

University / college / polytechnic examination results such as overall grades / cumulative grade point average, if applicableTahun pertama

First year 

Tahun kedua

Second year 

Tahun ketiga

Third year 

Tahun keempat

Fourth year 

Aktiviti-aktiviti semasa di sekolah / politeknik / kolej / universiti dan jawatan yang disandang

 Activities in school / polytechnic / college / university and leadership positions held 

Anugerah / hadiah yang dimenangi seperti pencapaian akademik, sukan dan pertandingan lain di sekolah / politeknik / kolej / universiti

Prizes / awards won such as academic / subject prizes, trophies, medals for sports / other competitions in school / polytechnic / college / university 

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KUOK FOUNDATION EDUCATIONAL ASSISTANCE – DATA FORM

PLEASE FILL IN SECTIONS I, II, III, IV, V & VI ONLY FOR OFFICE USE BL CR KIV I

I NAME OF APPLICANT RACE SEX  APPLICANT’S REF. NO.

* F / M FINANCIAL STATUS 

II  PARTICULARS OF COURSE TY: YPH: FS:

1. Name of Course REMARKS 

* Applied / Attending  No. of children

2. Name of *University / College / Polytechnic  Ranking in family

No. studying

3. Course Year (in the coming academic session)Father or   : Age  -

III  EXAMINATION RESULTS  (Do not write on shaded boxes) Guardian  : Occ  -: GY  -

1. *SPM / SPVM / ‘O’ Level results Year Mother   : Age  -

1AA+ 3B B+ 7D D : Occ  -

A 4B B 8E E : GY  -

2A A- 5C C+ 9G G6C C Siblings’ GY  -

2. UEC results Year 

A1 B3 B5 C7A2 B4 B6 C8

UEC refers to Unified Examination Certificate for Independent Chinese Secondary Schools in Malaysia.

3. *STPM / ’A’ Level results Year 

AA

DB-

RC-

A- C+ D+B B+ E C DC B

4. Matriculation results Year 5. MUET results

*CGPA / Overall Grade Band  

6. Latest *University / College / Polytechnic results Year 

*CGPA / Overall Grade

IV  HAVE YOU PREVIOUSLY APPLIED TO KF? *YES / NO

If yes, please state year applied :

V  ARE ANY OF YOUR * BROTHERS / SISTERS ASSISTED BY KF?

If yes, state his / her name :

VI  HAVE ANY OF YOUR * BROTHERS / SISTERS ALSO APPLIED TO KF THIS YEAR?

If yes, please state his / her name :

Note: KF refers to Kuok Foundation Berhad and * delete whichever is not applicable Please turn over to next page for instructions 

DOCUMENTS CHECKLIST 

(Please arrange your documents according to the order below)

PLEASE tick (  √  √√  √ ) either “Yes” or “No”. If “No” please explain why under “Remarks”

Have you enclosed certified copies of   Yes No Remarks 

1. University / College / Polytechnic acceptance letter 

2. Parents’ / Guardian’s proof of income for the past 2 years

3. Brothers’ and sisters’ proof of income for the past 2 years, if they are working

4. Letters or documents to prove that brothers and sisters are pursuing higher education in universities / colleges / institutions

5. University / College / Polytechnic results (Actual/Forecast)

6. STPM / ‘A’ Level / Matriculation / Foundation (Actual/Forecast) & MUET results

7. SPM / SPVM / ‘O’ Level / UEC results (Actual/Forecast)

8. Identity card and birth certificate of applicant

9. Birth certificates of all brothers and sisters

10. Parents’ / Guardian’s identity cards or death certificate, if deceased

11. School leaving certificates  

12. School testimonials (if any) 

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INSTRUCTIONS

PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE FILLING DATA FORM 

1. Please write or type clearly in BLOCK LETTER and complete DATA FORM in ENGLISH .

2. Please state “ NA” in those sections which are not applicable to you.

3. The DATA FORM should be attached to the front page of the Kuok Foundation’s officialapplication forms.

4. In SECTION  II, Nos. 1 & 2 you should state only your  first choice  of course and university    / college / polytechnic , if you are waiting for acceptance into university /

college / polytechnic.

5. In SECTION II, No. 3, “Course Year” refers to whether you are in Year 1, 2 etc. inthe new academic session.

6. In SECTION III, Nos. 1, 2 & 3, please state number of distinctions or credits or passesobtained, for example :

SPM RESULTS 2009  TO COMPLETE IN THIS MANNER 

Bahasa Melayu  - A+Bahasa Inggeris  - A-

Pendidikan Moral - BSejarah  - A-Mathematics  - BAdditional Mathematics - C+Physics  - B+Chemistry  - B+Biology  - B+Bahasa Cina  - C+English for Science  - A

and Technology 

1. *SPM / SPVM / ‘O’ Level results  Year   2009 

1AA+ 1 3B B+ 3 7D D

A 1 4B B 2 8E E

2A A- 2 5C C+ 2 9G G

6C C

7. Please ensure that all sections of the application form have been completed. Incompleteapplication will be disqualified.

DEADLINE FOR SUBMISSION OF DOCUMENTS 

If any of the documents are not immediately available, please submit them within 1 monthfrom the closing date for application.