GREAT EASTERN SUPREMACY SCHOLARSHIP AWARDS APPLICATIONS

Instructions to Applicants

1. Read the instructions carefully. Incomplete application forms and applications that do not comply with the
requirements can result in unsuccessful application.

2. All applications are to be sent via email to scholarship@greateasternlife.com with the subject "Supremacy
Scholarship Awards Application - YOUR FULL NAME (IC Number)” (as per your IC). E.g. Supremacy Scholarship
Award Application – ALI BIN ABU (980101-99-0123)

3. To complete this form, please download it, fill it up (you can type on the PDF document), save it, and send it to us to
the email address stated above. Please complete Section 9 – Declaration by printing the page out and signing at
the appropriate column. Upon signing you would need to send the scanned copy of Section 9 to the email
address stated above together with the application form.

4. Applications need to be completed in English.

5. All fields are compulsory and MUST be filled up. For fields that do not apply to you, please put as N/A (not
applicable).

6. Applicants MUST ONLY attach these items in their application: (all documents can be in PDF, DOC, GIF or JPEG
formats)
• Recent passport sized photo
• Scanned certified true copy of Identification card (front & back)
• Scanned certified true copies of academic certificates & transcripts (STPM / UEC / A-Levels / SAM / CPU /
Matriculation / Diploma / etc.)
**Please note: Applicants are required to bring original document of the above and other relevant documents
if they are further shortlisted.

7. All documents that are not in English, Bahasa Malaysia or Mandarin, MUST be translated and certified before
submission to us.

8. All applications MUST reach us by 31 March 2019.

9. ONLY successful applicants will be notified via email and / or telephone.

Students are required to enclose the following documents (certified true copy) with your duly completed scholarship
application form before returning to Great Eastern Life for processing

1 Duly completed Application Form

2 My Kad (identification card)

3 Recent passport sized photo

4 STPM, UEC, A-Levels, SAM, CPU. Matriculation, Diploma certificates or its equivalent

Please ensure the application form is complete with the above documents before you mail your application to us

for processing. Applications with incomplete documentation will not be considered.

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 GREAT EASTERN LIFE ASSURANCE MALAYSIA BERHAD
APPLICATION FOR
SUPREMACY SCHOLARSHIP AWARD
Photograph

COURSE OF STUDY: 1)
(In order of preference) 2)
3)

UNIVERSITIES APPLIED TO: 1)

2)
3)

Important: The form must be fully completed. State ‘Not Applicable’ for sections / areas which do not apply to you

SECTION 1 – PERSONAL PARTICULARS

Full Name: ______________________________________________ Gender: _____________________

Permanent Address:

Street Name 1: _____________________________________________________

Street Name 2: _____________________________________________________

Post Code: ______________ City: ______________________ State: _______________________

Contact No.: __________________________________________ Home Tel. No.: _______________________

Email Address: __________________________________________

Place of Birth: ___________________________________________

My Kad No. (961223-08-1234): ______________________________

SECTION 2 – EXTRACURRICULAR ACTIVITIES (Last 2 years only)

Society or Club Position Held Duration List of Activities of Society or Club

Level Represented
Sports Participated (School/District/State/ Date Achievements (If any)
Country)

Important: If you are currently studying in a University, kindly refer to Section 6 of this form

Page 2 of 6
SECTION 3 – EDUCATION

A) Sijil Pelajaran Malaysia – SPM or equivalent

School: _______________________________________ Year of Exam: _____________________________

Please list all subjects

Subjects Grade Subjects Grade

Bahasa Malaysia
English
Mathematics
Sejarah
Pendidikan Islam/Moral

B) Sijil Tinggi Pelajaran Malaysia – STPM/A-Levels/Matriculation or equivalent

School: ______________________________________ Year of Exam: _____________________________

Please list all subjects

Subjects Grade Subjects Grade

C) Other post STPM qualifications

Qualification Obtained Examining Body Year Grade / CGPA Obtained

Please attach certified true copies of your result slips or certificates along with the application form

SECTION 4 – PERSONAL ACHIEVEMENTS

Please list any information that you wish to bring to the attention of the Scholarship Selection Committee (in not more than 50 words).

SECTION 5 – FAMILY PARTICULARS

List out below the names of your father, mother, brothers and sisters. Please use separate sheet, if necessary.

Full Name Relationship Age Occupation Salary (RM)

1) Type of house you are presently living in? Own house/Rented/Others* _____________________________
2) Is either of your parents involved in business? Yes/No * If yes, what type of business __________________
3) What assets/property (ies) other than you family home, do your parents own, please list below:

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 Assets/Property(ies)
Value

1) _________________________________________________ __________________________
2) _________________________________________________ __________________________
3) _________________________________________________ __________________________
4) _________________________________________________ __________________________
5) _________________________________________________ __________________________

* Delete where not appropriate

If you are shortlisted, you will be required to bring along original documents to verify the above information.

Please list the Insurance Policy(s) that you or your parents currently own with Great Eastern Life:

Name of Agent who sold you the

Name of Policyholder Policy No. Date of Issue
Policy (if possible)
1)
2)
3)
4)

SECTION 6: ONLY FOR APPLICANTS PRESENTLY STUDYING AT UNIVERSITIES

Current university: ________________________________________________ Year admitted: __________________

Course of study: __________________________________________________ Major: _________________________
How is your study being financed currently? Self/ Loan/ Scholarship (Delete where not applicable)
If you are receiving loan/ scholarship, please state the source: __________________________________
and amount: __________________________________

SECTION 7 – BRIEF EXPLANATION

a) Tell us why you deserve this scholarship and how you can contribute to Great Eastern Life (in not more than 50 words).

b) Where did you find out about our supremacy scholarship programme? (Please tick at the relevant box/es)

1. Social Media (Please specify: ____________________________________ )

2. Website (http://__________________________________________ )

3. Newspapers (Please specify: ____________________________________ )

4. Family/friends

5. Great Eastern Life Planning Advisor/ Great Eastern Life Agent

6. Others (Please specify: ____________________________________ )

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SECTION 8 – DATA PROTECTION/ DATA PERIBADI

We, Great Eastern Life Assurance (Malaysia) Berhad and our group of companies will use the information and documents
which is provided to us on and in connection with this application for scholarship award, together with other information and
documents we may obtain about you, to assess your suitability for a scholarship award from us, for administration and
management purposes and for statistical analysis. We may disclose your information to companies within our group of
companies, our service providers and agents for these purposes.
Your information is necessary to us. If you do not provide all the information requested herein or if you do not consent to the
use of such information in the manner set out herein, the Company may not be able to award you with our scholarship.
If your application is unsuccessful, we will keep your information for a reasonable period in accordance with legal
requirements and for administration purposes.
If you provide us and/or our service providers and agents with any information about your physical and mental health,
religious beliefs, or criminal convictions (if any), you consent to our processing such information for the purposes described
above.
You have the right to ask for a copy of the information which we hold on you and which is subject to the applicable data
protection laws in Malaysia (for which we may charge a reasonable fee for access) and to correct any inaccuracies in your
information. However, the information that we may release to you does not include information containing personal data of
another data subject which includes, but is not limited to, the assessments and/or views of our interviewees or assessors of
you.
You also consent to our transferring your information to the regional offices of the Great Eastern Holdings Limited group of
companies (“Great Eastern Group”), which may not provide the same level of data protection as Malaysia, if necessary for
the purposes described above. If we do make a transfer we will take all reasonable steps to ensure that your information is
protected
If you would like to make the above request or have any inquiry or complaint (such as limiting the processing of certain
information), you may contact our Privacy Officer at 03-4813 3796.
We may also contact you if other scholarship award intakes arise in the future which we think may be suitable for you, either
with us or with other companies in the Great Eastern Group. If you do not wish us to contact you for this purpose,
please tick this box □.

Kami, Great Eastern Life Assurance (Malaysia) Berhad dan kumpulan syarikat kami akan menggunakan maklumat serta
dokumen yang diberi, berkenaan dan berhubung dengan permohonan untuk tajaan biasiswa, berserta maklumat dan
dokumen lain yang diperoleh berkaitan anda, untuk menilai kesesuaian anda menerima tajaan biasiswa daripada kami,
untuk tujuan pentadbiran, pengurusan serta analisa statistik. Kami mungkin mendedahkan maklumat anda kepada syarikat
di bawah kumpulan syarikat, penyedia perkhidmatan dan ejen kami bagi tujuan ini.
Maklumat anda adalah penting untuk kami. Jika anda tidak menyediakan semua maklumat yang diperlukan dalam borang
ini atau jika anda tidak membenarkan maklumat tersebut digunakan seperti dinyatakan dalam borang ini, Syarikat mungkin
tidak dapat memberi tajaan biasiswa kepada anda.
Jika permohonan anda tidak berjaya, kami akan menyimpan maklumat anda untuk suatu tempoh tertentu, mengikut
keperluan undang-undang dan tujuan pentadbiran.
Jika anda memberikan kami dan/atau penyedia perkhidmatan serta ejen kami berkenaan sebarang maklumat berkaitan
keadaan fizikal dan kesihatan mental, kepercayaan agama atau sabit kesalahan (jika ada), anda telah membenarkan kami
untuk memproses maklumat tersebut bagi tujuan yang dinyatakan di atas.
Anda berhak meminta salinan maklumat berkaitan anda yang dipegang oleh kami dan tertakluk kepada undang-undang
perlindungan data yang berkaitan di Malaysia (kami mungkin mengenakan bayaran yang berpatutan untuk melakukan
capaian) serta membetulkan sebarang maklumat yang tidak tepat berkaitan anda. Namun, maklumat yang kami keluarkan
kepada anda tidak mengandungi data peribadi berkaitan perkara lain yang termasuk serta tidak terhad kepada penilaian
dan/atau pandangan penemu duga atau penilai kami ke atas anda.
Anda juga membenarkan kami untuk memindahkan maklumat anda kepada syarikat serantau di bawah kumpulan syarikat
Great Eastern Holdings Limited (“Kumpulan Great Eastern”), yang mungkin tidak memberi perlindungan data yang setara
seperti di Malaysia, jika perlu, untuk tujuan yang dinyatakan di atas. Sekiranya kami melakukan pemindahan data, semua
langkah yang munasabah akan diambil bagi memastikan maklumat anda dilindungi.
Jika anda ingin membuat permohonan di atas atau mempunyai sebarang pertanyaan atau aduan (seperti mengehadkan
pemprosesan sesetengah maklumat), anda boleh menghubungi Pegawai Privasi Syarikat kami di 03-4813 3796.
Kami mungkin menghubungi anda jika terdapat tawaran tajaan biasiswa lain pada masa hadapan yang mungkin
bersesuaian untuk anda, sama ada dengan kami atau syarikat lain dalam Kumpulan Great Eastern. Jika anda tidak mahu
dihubungi untuk tujuan ini, sila tandakan kotak berikut □.

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SECTION 9 - DECLARATION

I, I/C No. hereby certify that all

statements made in this application are true and complete to the best of my knowledge and have not withheld any information
which might influence the consideration of this application. I understand that any misrepresentation / false declaration or omission
will be sufficient cause for cancellation of consideration for scholarship. I also authorize any investigation of the above information
for the purpose of verification.

Application Date Applicant’s Signature

FOR GREAT EASTERN LIFE USE

Eligible: Not Eligible:

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