Professional Documents
Culture Documents
Please read the following instructions carefully before completing the application:
1. Each applicant is allowed to submit ONE application only.
2. All required supporting documents MUST be certified ‘true copies’ as per the original documents
Please paste your
by the relevant authorities. recent passport-
3. All fields in the form must be filled up properly and clearly and must not be left blank. State “Not sized photograph
here
Applicable” or “‘NA” for areas that that are not applicable to you.
4. Ensure your application is for courses at the public and/or private universities and/or colleges
approved by Cagamas only, for which you have gained acceptance to.
5. Please send the duly completed form with all the required supporting documents latest by
25 June 2018 to:
Residential Address :
Nationality : Gender :
Date of Birth :
SECTION B UNIVERSITIES AND FIELD OF STUDIES (PLEASE LIST YOUR TOP 3 CHOICES)
NO COURSES UNIVERSITIES
1. 1.
2. 2.
3. 3.
Name of School :
Detailed Grade:
1. 11.
2. 12.
3. 13.
4. 14.
5. 15.
6. 16.
7. 17.
8. 18.
9. 19.
10. 20.
Detailed Grade:
1. 6.
2. 7.
3. 8.
4. 9.
5. 10.
1.
2.
3.
4.
5.
Age : Age :
Occupation : Occupation :
2. Father
4. Mother
5. Applicant
1.
2.
3.
TOTAL
Other Information: (Please tick at the appropriate column and provide the information accordingly)
1. Current residence: Owned, fully paid Owned, under mortgaged: Monthly instalment RM________
3. Do your parents/legal guardian own any lands / houses / shoplots or other immovable assets? Yes No
a) If yes, please state the type and estimated value : Type : _______________________ Value : RM _____________
4. Do your parents/legal guardian have any shares, unit trusts or other investments? Yes No
a) If yes, please state the type and estimated value : Type : _______________________ Value : RM _____________
5. How many of your siblings (if any) contribute to the household income? _____________________
1.
2.
3.
4.
5.
6.
7.
8.
Do you have relative(s) working at CAGAMAS? If Yes, please furnish details: Yes ( ) No ( )
Are you presently receiving any financial assistance from any institution / foundation / government, etc? If Yes, please
furnish details: Yes ( ) No ( )
Have you applied for any other Scholarships / Grants / Educational Loan? If Yes, please furnish details:
Yes ( ) No ( )
SECTION F EVALUATION
How did you find out about CAGAMAS Scholarship programme? Please tick at the appropriate boxes.
Please provide names, addresses, occupations and contact nos. of two (2) referees who are not related to you for us to
contact as character references. Please ensure that you get the consent of the referees before disclosing their personal data
to us.
Referee 1:
Residential Address :
Referee 2:
Residential Address :
It is our policy to retain the personal data of unsuccessful applicants for a period of 12 months from the date
of application. To access or correct your information, please write to the Human Capital Department to the
attention of Assistant Vice President Human Capital of telephone: 03 2262 1803 (details of which are on the
first page of this form) with your name, correspondence address, contact number and details of your
request.
I also authorise any investigation of the above information for the purposes of verification. I confirm that I
have obtained the consent of my parent(s), legal guardian(s), siblings(s), referee(s) and/or other third parties
to disclose their personal data as requested in this form.
_______________________________________ ___________________________________
Applicant’s Signature Date
Certified true copy of National Registration Identification Card (Both Sides on A4 paper)
Certified true copy of Sijil Pelajaran Malaysia and other higher education transcript
Cagamas accepts documents that are certified by any of the following individual:-
1. Grade A Government Officer
2. School Principal/Headmaster
3. Commissioner of Oath
4. “Ketua Kampung”
5. “Ahli Jawatankuasa Kemajuan dan Keselamatan Kampung”
6. The employer or authorised representative of the employer
Comments:-