PART A: ACADEMIC PROGRAMME
University :
Please attach
your recent
passport photo
here
Degree :
Majoring (if any)
Current Semester :
Total Semester :
Intake :
month _________________ year _________________
Target Date of Completion :
month _________________ year _________________
Current CGPA :
PART B: PERSONAL DETAILS
Full Name (as in NRIC) :
NRIC No. :
-
(Please attach Copy of NRIC)
Gender :
MALE
-
Date of Birth :
FEMALE
d
d
m
m
y
y
Marital Status :
Race :
Religion :
(H)
Contact No. :
(M)
Email Address :
Permanent Address :
Correspondence Address :
PART C: ACADEMIC QUALIFICATIONS (Please attach certified copies of your results and certificates)
Level
Name of School/ Institution
Grade Obtained
A
SPM/SPMV
B
C
D
Completion Year
Others
STPM/A-Level
Matriculation
Diploma
FOR HR USE ONLY
Date Received _______________
Application No. _______________
Status _______________
Scoring _______________
HRD-LHCD/June2014.yan
PART D: FAMILY BACKGROUND (Please attach certified copies of latest Payslips/Pension card)
No.
Name of Father/Mother/Guardian
No.
Name of Siblings
Relationship
Age Occupation
Occupation /
Age
Form/Standard
Company/
School
Monthly Income
Monthly Income
*Additional Info for Children of Agrobank Employees (Kindly ignore this if NOT applicable)
Name of Father/Mother :
Staff No :
Designation/Grade :
Unit/Department :
Division :
Joined Date :
Does your spouse works for Agrobank?
NO
YES (Please specify):
Name :
Staff No. :
Unit/Department :
Division
FOR HR USE ONLY
Date Received _______________
Application No. _______________
Status _______________
Scoring _______________
HRD-LHCD/June2014.yan
PART E: EXTRA CURRICULAR ACTIVITIES (Please attach certified copies of certificates) - PAST 2 YEARS ONLY
No.
Name of Club/Society/Association/Activities
Position
Held/Level
Presented
Achievement
Year
PART D: OTHER INFORMATION (Please attach certified copies of Offer Letter of Loan/Scholarship)
Are you holding PTPTN Loan?
NO
YES (If yes, please state amount (RM) per year):
Are you holding other sponsorship?
NO
YES (If yes, please state amount (RM) per year):
Name of Organization/Sponsorship :
PART E: DECLARATION
I, _________________________________________, (NRIC No.)________________________________, hereby declare that the information
given in this application form is complete, accurate and I agree to abide by the above conditions. I understand that any
information given falsely or withheld will affect the decision of my application, and may result in my inegilibility for
the scholarship award.
………………………………………………………..
Name of Applicant :
Date
:
……………………………………………………………………
Name of Parent/Guardian :
Date
:
The complete application form with relevant documents should be addressed to:
HR Learning & Human Capital Development
Human Resource Division ,Level 12, Menara Agrobank
Leboh Pasar Besar,P.O.Box 10815,
50726, Kuala Lumpur
Please indicate AGROBANK SAP 2015 at the top right hand corner of envelope. For further clarification, please
contact En Mohd. Zamil at 03-2731 1600 etxn 1244
FOR HR USE ONLY
Date Received _______________
Application No. _______________
Status _______________
Scoring _______________
HRD-LHCD/June2014.yan