MIDF Education Scholarship Programme 2020
IMPORTANT :
1. Please read this form carefully before filling up.
2. All Information given herein will be treated in strict confidence.
SECTION A : INSTRUCTION
1. Please complete all the information required in the form.
2. Submit the form via email to edu.scholarship@midf.com.my
3. If you are shortlisted, the following documents will be required:
STPM 2020 Leaver
 Copy of Identification Card
(NRIC)
 School Leaving Certificates
 School Testimonials (if any)
 Copy of STPM result
 Income Statement as follows:
 Parents’ / Guardian’s
latest pay slip (2020)
AND/OR
 Form J from ‘Inland
Revenue Board’ (LHDN)
OR Income Declaration
for those with no income
duly certified by
Commissioner of Oath
(Pesuruhjaya Sumpah)
OR
 Copy of Pension Card
and latest pension slip
(2020) duly certified by
Commissioner of Oath
(Pesuruhjaya Sumpah)
 Document stating the
financial assistance received
from other organisations /
sources (if any)
Pre-University Level
First Year of Bachelor’s Degree
(Foundation/Matriculation )
 Copy of Identification Card  Copy of Identification Card
(NRIC) (NRIC)
 School Leaving Certificates  School Leaving Certificates
 School Testimonials (if any)  School Testimonials (if any)
 SPM / SPVM / Results  SPM / SPVM / ‘O’ Level / ‘A’
Level / Matriculation /
 Latest Pre-University Level
Foundation / University/College
(Foundation/Matriculation )
Results
 University/College
 University/College acceptance
acceptance letter (if any)
letter
 Income Statement as follows:
 Document stating the course
 Parents’ / Guardian’s fee from the University/College
latest pay slip (2020)
 Academic Calendar
AND/OR
 Form J from ‘Inland  Income Statement as follows:
Revenue Board’ (LHDN)
 Parents’ / Guardian’s latest
OR Income Declaration
pay slip (2020) AND/OR
for those with no income
 Form J from ‘Inland
duly certified by
Revenue Board’ (LHDN)
Commissioner of Oath
OR Income Declaration for
(Pesuruhjaya Sumpah)
those with no income duly
OR
certified by Commissioner
 Copy of Pension Card
of Oath (Pesuruhjaya
and latest pension slip
Sumpah) OR
(2020) duly certified by
 Copy of Pension Card and
Commissioner of Oath
latest pension slip (2020)
(Pesuruhjaya Sumpah)
duly certified by
 Document stating the Commissioner of Oath
financial assistance received (Pesuruhjaya Sumpah)
from other organisations /
 Document stating the financial
sources (if any)
assistance received from other
organisations / sources (if any)
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SECTION B : APPLICANT PERSONAL DATA
Name (as per NRIC) :
Address :

NRIC No. : Nationality :

Tel No.(House) : Tel. No. (Mobile) :

Date of Birth : Place of Birth :
Gender : Female / Male Religion :
Marital Status : Single / Married / Divorced / Widow Race :
Email Address :

SECTION C : FAMILY INFORMATION

FATHER / GUARDIAN
Name Age :
NRIC No.
Contact No. (House / Mobile)
Current Employer & Address

Designation / Position
Monthly Gross Income (RM):
(as per pay slip or other income statement provided)

MOTHER / GUARDIAN
Name Age :
NRIC No.
Contact No. (House / Mobile)
Current Employer & Address

Designation / Position
Monthly Gross Income (RM):
(as per pay slip or other income statement provided)

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DETAILS OF SIBLINGS
(Please fill in according to age, eldest first)
NAME AGE GENDER OCCUPATION NAME OF EMPLOYER/INSTITUTION

* Add additional sheet if the table is not sufficient

SPOUSE (IF ANY)

Name Age:
NRIC No.
Contact No. (House / Mobile)
Current Employer & Address

Designation / Position
Monthly Gross Income (RM) :
(as per pay slip or other income statement provided)
DETAILS OF CHILDREN (IF ANY)
NAME DATE OF BIRTH GENDER

* Add additional sheet if the table is not sufficient

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SECTION D : EDUCATION INFORMATION
NAME OF SCHOOL / INSTITUTION FROM TO COURSE/MAJOR

SECTION E : ACADEMIC RESULT INFORMATION

EXAMINATION YEAR RESULT

SPM / SPVM

STPM

MATRICULATION / FOUNDATION

1ST YEAR DEGREE

OTHERS

SECTION F: CURRENT FIELD OF STUDY

Course/Major Location of
Institution

Name of Institution Expected Duration

of Study

Commencement of Expected
Study Completion of Study
(mm/yyyy) (mm/yyyy)

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SECTION G : EXTRA CO-CURRICULAR ACTIVITIES/SPORTS
STUDENTS SOCIETY/ASSOCIATION/CLUB POSITION HELD ACHIEVEMENT YEAR

* Add additional sheet if the table is not sufficient

SECTION H : FINANCIAL ASSISTANCE

Details of past and present assistance, including loans, if any, received from other organizations or other sources

Year Loan or Scholarship Name of organisation / Amount (RM) Bonded/Contractual

received other sources Employment Obligation
(circle any)
Yes No

Yes No

Yes No

* Add additional sheet if the table is not sufficient

DECLARATION

I hereby declare that the information given in this form is true to the best of my knowledge and that I
have not willfully suppressed any material fact relevant to this application. I understand that MIDF
BERHAD has the right to reject my application if the information provided in this form is found incorrect
or inaccurate during validation.

Name : _____________________________ Signature : __________________________

NRIC No. : ___________________________ Date : __________________________

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DOCUMENT CHECKLIST

The following documents will be required IF you are shortlisted for interview session. Only shortlisted
candidate will be notified.

Original Certified True Copy

No. Documents
(Yes/No) (Yes/No)

1. University/College acceptance letter

2. Document stating the course fee from the University

3. Academic Calendar

4. Identification Card (NRIC)

5. SPM / SPVM results

6. STPM / Matriculation / Foundation results

7. University/College results

8. School Leaving Certificates

9. School Testimonials (if any)

Income Statement as follows:

10.
 Parents’ / Guardian’s latest pay slip (2020)
AND/OR
 Form J from ‘Inland Revenue Board’ (LHDN) OR
Income Declaration for those with no income duly
certified by Commissioner of Oath (Pesuruhjaya
Sumpah) OR
 Copy of Pension Card and latest pension slip
(2020) duly certified by Commissioner of Oath
(Pesuruhjaya Sumpah)

11. Document stating the financial assistance received

from other organizations / sources