Yayasan KLK Scholarship Application Form

YAYASAN KLK

SCHOLARSHIP APPLICATION FORM
I. Personal Particulars

Tell us about yourself
Full Name (as per NRIC)

First NameLast Name
NRIC
YYMMDD-XX-XXXXFormat: 000000-00-0000.
Correspondence Address

Street Address

Street Address Line 2

CityState

Postcode
Date of Birth

DayMonthYear
Gender
Nationality
Please specify
Please specify nationality
Marital Status
Mobile Number
(Example: 012-3456789)Format: (000) -0000000.
Email Address

Hobbies

Rows	Hobbies
1
2
3

Name of University
Indicate (if any) which branch campus you are studying in
University Offer Channel

Other
If others, please specify
Please specify the university offer channel
Course of Study
Year of Study
Duration of Course
Please state the total duration of the course in years
Have you received any Scholarship Awards or financial assistance?
Date

DayMonthYear
Value
*How much the amount of scholarship that you received?
Have you applied for any other scholarship
If yes, provide details
Have you been employed previously?
Previous Employment Details (if applicable)
Please include company name, position held, and period of employment.
2. Family Information

Parent/Guardian 1
Full Name (as per NRIC)

First NameLast Name
NRIC
YYMMDD-XX-XXXXFormat: 000000-00-0000.
Correspondence Address

Street Address

Street Address Line 2

CityState

Postcode
Relationship
Occupation
Organisation
2. Family Information

Parent/Guardian 2
Full Name (as per NRIC)

First NameLast Name
NRIC
YYMMDD-XX-XXXXFormat: 000000-00-0000.
Correspondence Address

Street Address

Street Address Line 2

CityState

Postcode
Relationship
Occupation
Organisation

Sibling Details

Rows	Name of Siblings	Age (in numbers)	Occupation	Establishment/ Organisation
1
2
3
4
5
6

3. Academic Information

Please list all colleges and institutions you have attended

Rows	From(year)	To(year)	Name of Establishment	Education/Type of Training
1
2
3
4

4. Academic Record

STPM / Matriculation / Pre‑University Level or Equivalent
Name of Examination Passed
Please enter the type of examination taken (e.g. STPM, Matriculation, Pre-University or equivalent)
Year
Please enter the year the examination was taken

Please provide the subjects taken and grades obtained

Rows	Subjects	Grade
1
2
3
4
5
6
7

4. Academic Record

SPM
Year SPM was taken
Please enter the year the SPM examination was taken

Please provide the subjects taken and grades obtained for SPM

Rows	Subjects	Grade
1
2
3
4
5
6
7
8
9
10
11
12

5. Extra Curricular Activities/ Positions of Responsibility Held in School

Please enter your involvement in school activities and positions held, along with the respective year

Rows	Year	Details of Activities undertaken/ Positions held
1
2
3
4
5
6
7
8
9
10

6. Language Proficiency

Language Proficiency

Rows	Basic	Intermediate	Advanced
Bahasa Malaysia (Spoken)
Bahasa Malaysia (Written)
English (Spoken)
English (Written)

7. Character References

Please note that character references must not be family members or relatives

Please fill in the table

Rows	Name	Address	Relationship	Years known	Mobile No
1
2

8. Monthly Household Income & Expenditure

Estimated Monthly Household Income and Expenditure

Please provide your estimated monthly income and expenses in RM

Rows	RM
Parent/Guardian 1 Income
Parent/Guardian 2 Income
Other Sources

Total Income
The total is automatically calculated

Please provide your expenditure per month

Rows	RM
Household Expenses
Education Expenses
Other Expenses

Total Expenditure
The total is automatically calculated

Please provide your income tax payment for the past three years

Rows	Year	RM
1
2
3

9. Applicant's E-Signature

Applicant's Declaration and Acknowledgement
I hereby affirm and certify that all the information that I have included in this Application for Scholarship is truthful and accurate. I understand that Yayasan KLK has the right to withdraw the offer where it is discovered that I have misrepresented or omitted any information or facts in this Application for Scholarship.

I hereby (i) confirm and acknowledge that I have read, understood and accepted the contents of the Personal Data Notice Statement and Personal Data Protection Notice of Kuala Lumpur Kepong Berhad (“KLK”) at the official website of KLK, (ii) give my consent for the personal data to be used for the purposes of processing matters relating to my application for scholarship with Yayasan KLK and for all purposes incidental and/or associated with the same and (iii) confirm that, in respect of personal data of other individuals provided in this Application for Scholarship, I have obtained consent from that individual prior to providing their personal data to Yayasan KLK.
Signature of Applicant:
Date

DayMonthYear
Please upload the following supporting documents in in one combined PDF file containing the below listed required supporting documents:
- Recent passport-sized colour photograph
- SPM results/transcript
- Pre-University results/transcripts (e.g. STPM / Matriculation / Foundation / Diploma / A-Levels)
- University offer letter
- Proof of household income (e.g. salary slips / EA form / Income tax statements
Please rename the file using your full name (e.g., JohnTan.pdf) before uploading.
Please upload the documents:

Cancelof
Should be Empty:

YAYASAN KLK

I. Personal Particulars

2. Family Information

2. Family Information

3. Academic Information

4. Academic Record

4. Academic Record

5. Extra Curricular Activities/ Positions of Responsibility Held in School

6. Language Proficiency

7. Character References

8. Monthly Household Income & Expenditure

9. Applicant's E-Signature