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SHARIAH SCHOLARSHIP AWARD

NOTES FOR APPLICANT
1. All required documents must be submitted with the application form to the following address: Shariah Scholarship Award International Shariah Research Academy 2nd Floor, Annexe Block, Menara Tun Razak Jalan Raja Laut, 50350 Kuala Lumpur Malaysia

2. Application form should be accompanied a complete portfolio of

documents as follows: Certified academic certificates Letter of Offer from the institution of higher learning / INCEIF Photocopy of personal identification document (passport / birth certificate / identity card) Two letters of recommendation (for post-graduate study) Thesis proposal (for post-graduate study) Other relevant materials to support the application.

3. Please provide an official English translation if the certificates and academic transcripts are not in English. 4. False particulars or information will render you liable to disqualification. 5. Please indicate the type of scholarship applied on the left-hand corner of the envelope. 6. Bank Negara Malaysia will not bear any expenses incurred in the process of applying and attaining the scholarship.

Type of Scholarship: Post Graduate Name of Applicant Citizenship

CIFP

: Muhammad Zakky Ramadhany : Indonesia

Course Applied for : .......................................................................................... Name of University/ Institution: INCEIF

Full Name (capital letters): MUHAMMAD ZAKKY RAMADHANY PERSONAL DETAILS

First Name:Muhammad Zakky

Last Name/ Family Name:Ramadhany

Residential Address: Komplek Mitra Dago, Jalan Krisdoren J-9 Bandung Indonesia

House Telephone Number: +6222-7101780 Office Telephone Number: Mobile Telephone Number: +6281321872272 Fax Number: E-mail Address: inzakky23@yahoo.com MyKad/ IC No: Citizenship: Indonesia International Passport No: Passport Expiry Date: Place of Birth: Number of Children: Name of Father/Guardian: Rafani Akhyar Address of Father/Guardian: Religion: Islam Gender: Male Date/Placed Issued: Date of Birth: Age: Marital Status:

Telephone Number:

EDUCATIONAL QUALIFICATIONS Type of certificate/ Diploma/ Degree

School/College/ Institution

Date/ Year From Till

CGPA/ Class/ Grade

SPECIALIZATION (For tertiary level and above) Type of Diploma/ Degree/ Masters/ Professional Specialization Certification Title of Dissertation/ Thesis (if any)

Name and Address ofWORK EXPERIENCE (if any) Employer Designation

Period

SUMMARY OF THESIS PROPOSAL (must be in the area of Fiqh Muamalat) Topic Area: Supervisor/proposed supervisors name (if known): Telephone number:

Brief Summary of Thesis Proposal:

Research Experience. Please provide details of previous research or development work performed, together with reference to papers published. (add additional pages if necessary)

LANGUAGE PROFICIENCY

Level of Proficiency (E=Excellent, IM= Intermediate, B=Beginner) (Please name Name of Language the two persons who have completed your enclosed reference forms) Please indicate your level in the relevant spaces provided Speaking Writing Reading

4 REFEREES

1) Name: (Dr./Mr./Mrs./Ms)

2) Name: (Dr./Mr./Mrs./Ms)

Address:

Address:

E-mail Address: Telephone Number:

E-mail Address: Telephone Number:

Occupation:

Occupation:

APPLICANTS DECLARATION I declare that the particulars stated in this scholarship application and the attachments and that I have not willfully suppressed any material fact. Bank Negara Malaysia has the right to terminate my scholarship if the information given is found to be false. I authorize Bank Negara Malaysia to obtain from other educational institutions and relevant authorities, at any time, details of my enrolment, variations and attendance. I agree that these details may be made available to the Scholarship Evaluation Committee. I agree to abide by the conditions of the award as emended from time to time Date: ............................. Signature: ..................................