YSD POST GRADUATE (OVERSEAS) SCHOLARSHIP APPLICATION FORM

A. PERSONAL PARTICULARS

PHOTOGRAPH

Title/Salutation

Full Name as per

IC/Passport

New IC No.

Old IC No.
Date of Birth
Place of Birth
(DD.MM.YYYY)
Gender Age

Race Nationality

Religion Ethnicity Bumiputera Non-Bumiputera

Marital Status Single Married Divorced Widowed

No. of Children
(below 24 yrs old)

Contact Details

Contact No.

Email Address

Mailing Address

Unit No. and Street

Town/City Postcode

State Country

Contact No.

B. LANGUAGES AND DIALECTS PROFICIENCY

Read Speak Write

Languages / Dialects
Fluent Fair Fluent Fair Fluent Fair

Bahasa Malaysia

English

Mandarin

Tamil

Others:

Others:

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C. HIGHEST EDUCATIONAL AND QUALIFICATIONS PARTICULARS

Location Qualification Date (DD.MM.YYYY) Year Final

Name of Institution / (i.e. PHD, Discipline / Field Results
(Country / Achieved /
University / School MBA, BA, of Study From To (i.e. CGPA,
Town / City) Graduated
Dip) Class)

PROFESSIONAL MEMBERSHIPS
Name of Professional Body Membership No. Membership Class Year Obtained

KEY ACHIEVEMENTS

D. EMPLOYMENT RECORD

Total years of working experience: ________ years

PRESENT EMPLOYMENT
Name of Company Date Joined

Position

Years in the Company

For Sime Darby's employee, please complete the following section:

Company Name Postion Division SAP/Employee ID Date Joined

E. POSTGRADUATE PLACEMENT

Expected
Qualification Duration of
Name of Institution Field of Study Commenceme Expected Completion
(MSC, MBA, PhD) Study
nt

F. ADDITIONAL INFORMATION

Do you have any family members / relatives working in the Sime

Yes No
Darby Group?
If Yes, please provide the following details
Name Relationship Company Location Designation

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G. REFERENCE

REFEREE 1 (Other than relatives)

Name Occupation

Company Name

Company Address
Referee's Email
No. of Years Known
Address
Contact No.

REFEREE 2 (Other than relatives)

Name Occupation

Company Name

Company Address
Referee's Email
No. of Years Known
Address
Contact No.

Declaration
Have you ever been charged or convicted for the violation of any law, excluding minor traffic offences? (Yes/No)
Have you ever been charged of drug abuse or any other illegal substance under Malaysian law? (Yes/No)
Are you diagnosed with any illnesses, diseases or disorders? (Yes/No)

I hereby certify that the information provided by me above are complete and correct to the best of my knowledge;
I understand that any false statements or witholding of any relevant information may provide grounds for the withdrawal of any offer of
scholarships or for its immediate cancellation if the scholarship has been accepted.

SIGNATURE OF APPLICANT DATE

CheckList (Please Tick)

1. All details provided in the application form are valid

2. Supporting Documents:
Note: Before you submit, please ensure that the following documents have been "certified true copy"
A. Offer letter of admission from university
B. Copy of Bachelor Degree’s / Master’s Degree’s results
C. Copy of NRIC
D. Curriculum Vitae / Resume (please include details of working experience, qualifications, key achievements, etc.)
E. One (1) page of Abstract / Executive Summary of your proposed research or course of study
F. Latest Salary Slip

3. Obtain permission from Head of Department & HR Department to apply for YSD Scholarship Programme
(Applicable for Sime Darby staff only)

Name: Company Stamp:

(Sime Darby Group of Companies)
Position:
Date: