GREAT EASTERN LIFE ASSURANCE (MALAYSIA) BERHAD

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 [email protected] 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 (960101-99-0123)
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 2016.
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.
Page 1 of 6
GREAT EASTERN LIFE ASSURANCE MALAYSIA BERHAD
APPLICATION FOR
SUPREMACY OVERSEAS AND LOCAL SCHOLARSHIP AWARD
Photograph
COURSE OF STUDY :
(In order of preference)
1)
2)
3)
UNIVERSITIES APPLIED TO :
4)
5)
6)
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 :
Contact No. :
State :
Home Tel. No. :
Email Address :
Place of Birth :
My Kad No. (XXXXXX-XX-XXXX) :
SECTION 2 – EXTRACURRICULAR ACTIVITIES (Last 2 years only)
Society or Club
Position Held
Duration
List of Activities of Society or Club
Sports Participated
Level Represented
(School/District/State/
Country)
Date
Achievements (If any)
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
Bahasa Malaysia
English
Mathematics
Sejarah
Pendidikan Islam/Moral
Grade
Subjects
Grade
B) Sijil Tinggi Pelajaran Malaysia – STPM/A-Levels/Matriculation or equivalent
School :
Year of Exam :
Please list all subjects
Subjects
Grade
Subjects
Grade
Year
Grade / CGPA Obtained
C) Other post STPM qualifications
Qualification Obtained
Examining Body
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
1)
Relationship
Age
Occupation
Salary (RM)
Type of house you are presently living in?
Own house
Rented
Others :
Page 3 of 6
2)
Is either of your parents involved in business?
No
3)
Yes. Type of business :
What assets/property(ies) other than you family home, do your parents own, please list below:
Assets/Property(ies)
Value
1)
2)
3)
4)
5)
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 Policyholder
Policy No.
Date of Issue
Name of Agent who sold you the
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
If loan / scholarship, please state the
Source :
Scholarship
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
Please specify :
3)
Newspapers
Please specify :
4)
Family/friends
5)
Great Eastern Life Planning Advisor / Great Eastern Life Agent
6)
Others
http://
Please specify :
Page 4 of 6
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
.
Page 5 of 6
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.
Applicant’s Signature
Application Date
FOR GREAT EASTERN LIFE USE
Eligible
Not Eligible
Page 6 of 6