kuok foundation
TRANSCRIPT
8/6/2019 Kuok Foundation
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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.