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Fill the form in ALL CAPS (BLOCK) letters, and in English Only

Last Date: 03 Sept. 2012

High Commission of India


Kuala Lumpur
(Education Section)
*****
Level 28, Menara 1 Mont Kiara, No. 1, Jalan Kiara,
Mont Kiara, 50480 Kuala Lumpur
(Tel: 03 6205 2350 ext 203)
Indian Scholarship & Trust Fund (ISTF) application form for the Academic year 2012-13
(Only for Malaysians of Indian Origin studying at Universities / Colleges in Malaysia)
Paste your recent
Passport Size
photograph here
(Note: dont attach
the photograph with a
clip; dont staple the
photograph; instead
paste it firmly at the
centre of this box)
(A) Particulars of Applicant:
1. Full Name (in BLOCK letters): ...
2. Residence Address & Telephone Numbers:

Home Tel: Mobile: .


Email:
3. Date of Birth: Place of Birth: ...
4. Nationality: .
5. Identity Card Number:
6. Name of Institution of Higher Learning: ..

7. Course of Study:
8. Year of Study (whether 1st yr, 2nd yr, etc.): ...
9. Duration of Course: From To ..
10. Date of first joining the Institution: ..
11. Are you in receipt of grants, loan, scholarship or financial aid from other sources? If so,
please furnish details:

Ref: KUA/E/327/12/2012

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Fill the form in ALL CAPS (BLOCK) letters, and in English Only

Last Date: 03 Sept. 2012

12. In the past have you received scholarship from the ISTF? Please circle

YES / NO

13. If Yes, which Year & how much Amount?


(B) Particulars of parents and members of family:
1. Fathers Name: ..
2. Fathers Age: . Fathers Tel:
3. Fathers Occupation:
4. Fathers Monthly Income:
5. Fathers Employers Name i.e. Company Name: ..
Company Address:

Company Telephone Number:


6. Mothers Name: ...
6. Mothers Age: . Mothers Tel:
7. Mothers Occupation:
8. Mothers Monthly Income:
9. Mothers Employers Name i.e. Company Name:
Company Address:

Company Telephone Number:


10. Number of brothers in your family: How many of them are Unmarried?
11. Number of sisters in your family: How many of them are Unmarried?
12. Details of unmarried brothers & sisters who are employed, their monthly incomes & the
names of their employers i.e. company name:
#

Name

Designation /
Job Description

Income

Employer

1.
2.
3.
4.
13. Any immovable property such as land, house etc. owned by your parents? If so, please give
details:
#
1.

Property

Value (RM)

Annual / Monthly Income from the property

2.
Ref: KUA/E/327/12/2012

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Fill the form in ALL CAPS (BLOCK) letters, and in English Only

Last Date: 03 Sept. 2012

14. Name, address and telephone number of a person who can testify your character and
financial position of your family:

15. How is this person known to you?


16. Additional Information (if any) you wish to furnish in connection with your application:

Declaration
I, . hereby declare that the information given above is true
to the best of my knowledge and belief.
Date:

Signature:

Note:
1. All columns in the application form should be duly filled in. Defective application forms are
liable to be rejected.
2. Please attach photocopies of SPM / STPM mark sheet (for students just joining colleges) or
the latest mark sheet for the present course of study (for students already studying in
colleges). Original documents should NOT be attached.
3. Attach a letter of proof of studying from the institution i.e. bonafide certificate / letter.
4. Attach income statement photocopies of Both Parents.
5. In case any additional information is desired to be furnished, it can be given in separate
sheet and attached to this application.
6. The decision of the Selection Committee is Final and NO further correspondence will be
entertained in the matter.
7. Students currently pursuing their A Levels, Foundation in Science, South Australian
Matriculation (SAM), Candian Pre-U (CPU), etc., are NOT eligible to apply. Only students
doing Diploma, Graduate and Post-Graduate programmes are eligible to apply for the ISTF.
Ref: KUA/E/327/12/2012

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