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GREAT EASTERN SUPREMACY SCHOLARSHIP APPLICATION CHECKLIST Students are required to enclose the following documents (certified true copy) with your duly completed scholarship application form before returning to Great Eastern for processing

1 Duly completed Application Form

2 Birth Certificate

3 My Kad (identification card)

4 PMR, SPM, STPM, UEC certificates or its equivalent such as GCE A Levels

5 School leaving certificated and testimonials, if applicable

6 Co-curriculum activities’ certificates

7 Parents’ EA Form

8 Admission letter to university, if applicable

9 Any other documents which you feel will support your application for this

scholarship award

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 OVERSEAS AND LOCAL SCHOLARSHIP AWARD

INSTRUCTIONS a) Please attach certified true copies of Certificates / Testimonials pertaining to your education b) This form must be fully completed. State ‘Not Applicable’ for sections / areas which do not apply to you SECTION 1 – PERSONAL PARTICULARS

Full Name: ______________________________________________ Sex: ________________________

Permanent Address: __________________________________________________________________________

_______________________________________________________ Post Code: ___________________

Contact No.: __________________________________________ Home Tel. No.: ________________

Email Address: __________________________________________ Age: ________________________

Place of birth: ___________________________________________ Date of birth: _________________

My Kad No.: ____________________________________________

SECTION 2 – EXTRA MURAL ACTIVITIES (Last 2 years only)

Society of Club Position Held Duration List of Activities of Club

or Society

Sports Participated Level Represented

(School/District/State/ Country)

Date Achievements (If any)

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

Photograph

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Important:- If you are currently studying in a local Malaysian University, kindly refer to Section 6 on Page 3 of this form SECTION 3 – EDUCATION A) Sijil Pelajaran Malaysia - SPM School: _______________________________________ Year of Exam: _____________________________

Please list all subjects

Subjects Grade Subjects Grade

B) Sijil Tinggi Pelajaran Malaysia – STPM School: ______________________________________ Year of Exam: _____________________________

Please list all subjects

Subjects Grade Subjects Grade

C) Other qualifications (after STPM) – e.g. Matriculation, Semester Results, etc.

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

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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 home you are presently living in? Own home/Rented/Squatter/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: Assets/Property(ies) Value*

1) _________________________________________________ __________________________

2) _________________________________________________ __________________________

3) _________________________________________________ __________________________

4) _________________________________________________ __________________________

5) _________________________________________________ __________________________

* Delete where not appropriate If you are shortlisted, you will be required to bring along documents to verify the above information Please list the Insurance Policy(s) that you or your parents currently own with Great Eastern:

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 APPLICANS PRESENTLY STUDYING AT LOCAL UNIVERSITIES Current university: ________________________________________________ Year Admitted: __________________

Course of study: __________________________________________________ Major: _________________________

Student No.: __________________________

How is your study being financed currently? Self/ Loan/ Scholarship*

If you are receiving loan/ scholarship, please state the source: __________________________________

and amount: __________________________________

Please attach your semester results * Delete where not applicable

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SECTION 7 – BRIEF EXPLANATION a) Tell us why you deserve this scholarship and how you can contribute to Great Eastern. b) Where did you find out about our supremacy scholarship programme?

SECTION 8 – PERSONAL DATA

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.

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 Holdings Limited group of companies.

If you do not wish us to contact you for this purpose, please tick this box □.

You also consent to our transferring your information to Great Eastern Group’s Regional Offices, 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.

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SECTION 9 – DECLARATION I, I/C No. do 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 OFFICE USE

Eligible: Not Eligible: Reasons for non-eligibility:

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