Bursary Form - Forms | Yayasan Sime Darby

Bursary Programme Form

YOUR DESIRED BURSARY PROGRAMME

CURRENT / PREFERRED UNIVERSITY*

CURRENT / PREFERRED FIELD OF STUDY*

*Disclaimer: The selection of field of study and university must correspond to the programme requirements within the Yayasan Sime Darby website.

B. PERSONAL PARTICULARS

FULL NAME (AS PER NRIC)

NEW NRIC NO.

Gender

AGE

Race

Marital Status

TYPE OF DISABILITY

OKU CARD NUMBER

*Please fill in 'N/A' if you are applying for YSD Special Support Bursary Programme

CONTACT DETAILS

MOBILE PHONE NO.

E-MAIL ADDRESS

LOCATION OF RESIDENCE

TOWN / CITY

STATE

C. FAMILY BACKGROUND

Father / Guardian 1's Details

FULL NAME (AS PER NRIC)

NEW NRIC NO.

RELATIONSHIP WITH CANDIDATE

MOBILE PHONE NO.

E-MAIL ADDRESS

EMPLOYMENT STATUS

OCCUPATION

MONTHLY GROSS INCOME (RM)

MARITAL Status

MOTHER / Guardian 2's Details

FULL NAME (AS PER NRIC)

NEW NRIC NO.

RELATIONSHIP WITH CANDIDATE

MOBILE PHONE NO.

E-MAIL ADDRESS

EMPLOYMENT STATUS

OCCUPATION

MONTHLY GROSS INCOME (RM)

MARITAL Status

Parents' / GUARDIANS' details

For divorced / REMARRIED PARENTS, please state which parent is financially supporting the candidate

D. EDUCATIONAL AND QUALIFICATION PARTICULARS

LATEST EXAMINATION RESULTS

INSTITUTION / SCHOOL NAME

YEAR

EDUCATION LEVEL

RESULT (CGPA / NO. OF SPM CREDITS)

E. SIGNIFICANT AWARD / ACHIEVEMENT / COMPETITION

NAME OF AWARD / ACHIEVEMENT / COMPETITION

YEAR

LEVEL

F. LEADERSHIP

NAME OF CLUB / SOCIETY

YEAR

LEADERSHIP POSITION

G. Declaration

Have you ever been charged or convicted for the violation of any law, excluding minor traffic offences?

Yes
No

Have you ever been charged of drug abuse or any other illegal substance under Malaysian law?

Yes
No

Are you diagnosed with any illnesses, diseases or disorders?

Yes
No

I hereby certify that the information provided by me above are complete and correct to the best of my knowledge;

I understand that any false statements or witholding of any relevant information may provide grounds for the withdrawal of any offer of scholarships or for its immediate cancellation if the scholarship has been accepted;

I understand that my application may be disqualified in the event that I have not attached all relevant supporting documents below.

H. SUPPORTING DOCUMENTS

Item 1 - 5 are compulsory. The supporting documents are to be uploaded in 1 PDF file (Max. size 3MB)

Copy of applicant's NRIC,
Copy of recent examination result,
Copy of father's / guardian's pay slip / income declaration / EA form / pension statement,
Copy of mother's / guardian's pay slip / income declaration / EA form / pension statement,
Copy of 3 latest co-curricular activity / society / club certificates,
Copy of parents' divorce certificate / death certificate (if any), and
Copy of applicant's OKU card (if any)

IMPORTANT NOTE: These documents should be combined in a single PDF file with a total size not exceeding 3MB.

SUPPORTING DOCUMENTS

By checking this box, I hereby declare that I have read, understand and agree to the PDPA disclaimer below.

SUBMIT

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