Sir J. Moilin Ah Chuen Foundation Application Form

Sir J.

Moilin Ah Chuen Foundation Scholarship Scheme
Application Form
Please fill in the blanks or tick as appropriate.
First Name: ___________________________________________________
Other Names: _________________________________________________
Surname: ________________________________________
Nationality: ______________________________________
Date of Birth: __________________________
National ID Number: ____________________________
Sex:

Male
Female

Marital Status:


Single
Married
Divorced

Address: __________________________________________________________
Phone number (home):_________________________ Mobile: ________________________
Email address: ____________________________________________
Tertiary institution:

University of Mauritius

University of Technology Mauritius

Others, please specify:_____________________________________________________

Student ID Number (if applicable): ______________________________
Faculty/Program of studies/course enrolled: ______________________________________
Year/Term of studies: ____________________________________________
Amount payable:

Part Time
Full Time

Annual fee of course in Mauritian Rupees: Rs____________________

Career Goals
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Why do you need a Scholarship?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Have you applied to other Scholarship scheme for the Academic Year 2013/2014?

Yes Please Specify_________________________________________________
No

Have you benefitted from any Scholarship scheme for the Academic Year 2012/2013?

Yes Please Specify_________________________________________________
No

Have you benefitted from any Scholarship scheme for the Academic Year 2013/2014?

Yes Please Specify________________________________________________
No

Parent’s marital status:


Married
Divorced
Widower

Father’s Details
Full Name: __________________________________________________
Occupation: ________________________________________________
Employer: ___________________________________________________
Employee phone number: ___________________________________
Monthly Basic Salary: ________________________________________
Phone number: (home) :______________( Mobile):______________
Address: _____________________________________________________
Mother’s Details
Full Name: __________________________________________________
Occupation: ________________________________________________
Employer: ___________________________________________________
Employee phone number: ___________________________________
Monthly Basic Salary: ________________________________________
Phone number: (home) :______________( Mobile):______________
Address: _____________________________________________________

Deadline for application: 22th July, 2013

Applicants need to submit completed application form together with a scanned copy of

1. Latest Parent’s payslip,
2. University admission letter,
3. University official receipt(s)
4. University Student ID
5. National ID card,
6. Birth Certificate
7. Proof of address (recent CEB/CWA bill)
To: CSR Officer
Sir J.M. Ah Chuen Foundation
ABC Centre, 1 Military Road, Port Louis
Or by mail to: abc-foundation@abcgroup.mu

I certify that the information provided above is true and represents a complete history of
my academic and financial record. I authorize ABC Group of Companies representatives
to access my educational and financial records to determine my eligibility for the
scholarship.
Student’s Signature______________________________

Date: ___________________

The Foundation Reserves the right to call/select at its sole discretion, the best candidates
for this scheme. Terms and Conditions may apply.
OFFICE USE ONLY

Approved

Not Approved

Received by _________________________ Date: ______________ Signature___________________
Approved by _________________________ Date: ______________Signature___________________
Amount Awarded: Rs ___________________________

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