kuok foundation

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



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


Kerja separuh masa


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


Kerja separuh masa


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.



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



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)



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.

kuok foundation

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