观音亭福利基金奖学金申请表格 FORM: KITF-SS-01

Kwan Inn Teng Foundation Scholarship Application Form

Name 名字：
IC No 身份证： 申请日期
Date of application: _
Telephone No. 电话：

Section A：申请类别 Category Applied

请打勾（√）Please tick your current category(√ ) 编号 Reference Number (Official Use)

中学 / 独中 中六 / A-level / 先修班 文凭
Secondary School / Chinese STPM / A-level / Matriculation / Degree / Diploma
Independent. School Foundation

中学组 大学先修班 高校组

Secondary School
□ 初中一·Form 1
□ 初中二·Form 2
□ 初中三·Form 3
□ 高中一 / 中四·Form 4
□ 高中二 / 中五·Form 5
□ 高中三
NOTE: 附件 Required Attachments
1. Passport size photo
2. Photostat IC & birth
certificate
3. Parents’/Guardians’
photostat IC
4. Parents’/Guardians’ 2018
income tax/salary
slip/confirmation letter
5. School examination result
6. UPSR/PMR/PT3
examination result slip
(UPSR results only for form
1,2,3)
必须填的部分 Sections Required to be Filled
SECTION A, B, C, D, F
Pre-U Higher Education
□ 大学先修班一年级 □ 学院一年级
Lower Six College 1st year
□ 大学先修班二年级 □ 学院二年级
Upper Six College 2nd year onward
□ 大学一年级
University 1st year
□ 大学二年级以上
University 2nd year onward
□ 1. Passport size photo □ 1. Passport size photo □
□ 2. Photostat IC & birth □ 2. Photostat IC & birth □
certificate certificate
□ 3. Parents’/Guardians’ □ 3. Parents’/Guardians’ □
photostat IC photostat IC
4. Parents’/Guardians’ 2018 4. Parents’/Guardians’ 2018
□ □ □
income tax/salary income tax/salary
slip/confirmation letter slip/confirmation letter
□ 5. School examination result □ 5. School examination result □
6. SPM examination result 6. STPM/Pre-U examination
□ slip □ result slip □
7. College/University
acceptance letter (First □
semester only)
ALL SECTIONS
SECTION A, B, C, D, F (A, B, C, D, E, F)

OFFICE USE ONLY

Remarks
Process flow Name Date Signature (Please Circle)
Reviewer / Interviewer / Approver
Preliminary
Accept Reject
Review
Interview
Accept Reject

Accept Reject
Approval
Accept Reject

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 相片
Section B：个人资料 Personal Particulars
Photo

中文(Mandarin) 英文(English)
申请人姓名
Name of Applicant:

电话号码 Telephone No. :

身份证号码 NRIC No.: (you must be contactable via this number)

永久地址 Permanent Address:

通讯地址 Mailing Address:

(you can receive postal mail via this address)

出生日期 Date of Birth: (dd/mm/yy) 年龄 Age: 性别 Gender: Male / Female

Section C：家人资料 Family Particulars

父亲 Father 母亲 Mother

姓名
Name
身份证号码 NRIC

地址
Address

电话号码
Telephone No.
职业
Occupation
月薪
Monthly Income
雇主
Employer

拥有房屋或物产
者，请详细说明

若有兄弟姐
兄弟姐妹概况 / Particulars of brothers and sisters 妹报名请注
明
姓名 性别 年龄 职业 每月总收入 Please tick if
Name Sex Age Occupation Income per siblings
month register

1
2
3
4
5

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 Section D：课外活动 Co-curriculum

Section E：课程资料 Particulars of Courses

申请课程 / 就读 Course Applied / Attending: 学院名字与地址 Name and Address of Institution:

课程开始日期 Date of Commencement: 课程结束日期 Date of Completion of Course:

学历 / Academic

学校 / 学院 / 大学名称 从 From 至 To 文凭 Certificate

School / College / University

常年所需开销 / Estimated expenses per annum:

课程学费 RM 其它学费 RM
Tuition Fees: Other Fees:

住宿 RM 食物 RM
Accommodation: Food:

其它开支 RM 总额: RM
Other Expenditures: Total:

常年经费来源 / Estimated other source of financial support per annum

家庭资助 From Family: RM 其它资助 Other source: RM

兼职资料 Part Time Job: RM

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 Section F：宣誓 Declaration

证明人资料 / Particulars of Referees:

姓名& 1) 2)
身份证号码
Name & NRIC

地址
Address

电话
Telephone No.

请简述（100 字以内）你为何申请这项奖学金。
Please state (within 100 words) why you need to apply for the scholarship.

如你得不到这份奖学金, 你将如何完成你的学业?
If you do not obtain the scholarship, how would you complete your studies?

我真诚宣誓以上资料正确，并无虚言
I sincerely declare that the information given herein is true.

申请者签名
Signature of Applicant

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