AMMA Foundation (061151-D)

No. 40-B, Lorong Rahim Kajai 14, Taman Tun Dr Ismail, 60000 Kuala Lumpur.
Tel: +603-7725 8001/02 Fax: +603-7725 2070 www.ammafoundation.com.my

Study Loan Application Form

I. PERSONAL INFORMATION OF THE APPLICANT
a) Name

:
(as stated in NRIC)

b) NRIC No

c) Date of Birth

d) Citizenship

e) Permanent Address

f ) Correspondence Address :

g) Marital Status

h) Profession

Mobile :
j) E-mail address

II. ACADEMIC QUALIFICATIONS OF THE APPLICANT

Level
STPM

SPM

Others

Grade

Detailed Results

III. COURSE DETAILS

a) Course applied for

b) Date of Commencement

c) Name of the Institution

d) Duration of the Course

e) Fee Structure & Related Expenses

Particulars

Annual

Course fee
Food & lodging
Books
Others

Total

e) Amount of Loan Required

f ) Have you applied for any other loans?

If yes, give details

YES / NO

Total

IV. PARENTS PARTICULARS

Particulars
Name

Father

Mother

NRIC No
Address

Occupation
Office Address

Contact No.
Monthly Income
Details of Assets

Note: If the assets are under loan, please state. Please enclose two months salary slips/EA form of parents.
V. FOR APPLICANT WHO IS EMPLOYED
a) Profession

b) Organisation

c) Address

d) Contact No.

e) Monthly Income

VI. FOR APPLICANT WHO IS MARRIED

a) Spouses Name

b) NRIC No.

c) Permanent Address

d) Correspondence Address :

e) Profession

f ) Monthly Income

VII. DETAILS OF SIBLINGS

Name

Occupation Age Marital Status

Monthly Monthly Financial Support

Income to Parents (if any)

VIII. GUARANTORS
Particulars
Name

Guarantor 1

Guarantor 2

NRIC No
Date of Birth
Address (home)

Tel (home/HP)
Occupation
Address (office)

Tel (office)
Monthly Income
Note: Immediate family members cannot stand as Guarantors, and all Guarantors must be below the
age of 50.
IX. DECLARATION
We declare that the above information is true to the best of our knowledge.

Applicants Signature
Date:

Parents Signature
Date:

X. RECOMMENDATION BY AMMA AFFILIATE

(Signature of authorised official)

Name of Official

Position in Organisation

Official Affiliate Stamp

XI. FOR OFFICE USE ONLY

a) Recommended by Study Loan Committee

Signed by Chairman,
Study Loan Committee
Name :
Date :
b) Boards Decision

: Approved / Not Approved

c) Amount Approved

d) Date of Approval

e) Remarks, if any

(Signature of authorised official)