THE YAYASAN WAH SEONG SCHOLARSHIP AWARDS 2016

(For Local Public & Private Universities/Colleges only)

Type of Application

st

Public University/College
Private University/College

Please tick / the box

1 Degree
Diploma

Complete ALL sections in BLOCK LETTERS:

1. PERSONAL DETAILS
(Married applicants to also fill in Item 10)

Full name:

PARIMALAR A/P CHINNASAMY

NRIC No.
9301020105642
Date of Birth: 20/01/1993
Home Address:
State:

e-mail: parimalar20@yahoo.com

NO 401 BLOCK 17 HICOM FLATS TMN BUNGA NEGARA SEKSYEN 27 40400 SHAH ALAM SELANGOR DARUL EHSAN

Post code: 40400

SELANGOR DARUL EHSAN

Correspondence Address (if different from above):

Single/Married: SINGLE

NO 9 JALAN BANGSI EMPAT 33/18D TMN ALAM INDAH

SEKSYEN 33 40400 SHAH ALAM SELANGOR

State: SELANGOR DARUL EHSAN

Post code: 40400

Tel (Mobile): 01116355825

Tel (Home): 0356144266

2. ACADEMIC HISTORY (Begin with most recent qualification)

(Current undergraduates also to fill in Item 3)

Qualifications

Exam Year

Subjects
REFER THE ATTACHMENT AT THE BACK

STPM/Matriculation/
Foundation/Diploma*
(delete not applicable)

SPM

Grades/CGPA
3.17

2014

----------

2010

----------

BAHASA MELAYU

A-

BAHASA INGGERIS
PENDIDIKAN MORAL
SEJARAH

B+
B+
AAC+
B
C+
C+

MATHEMATICS
ADDITIONAL MATHEMATICS

PYHSICS
CHEMISTRY
BIOLOGY
EST

* Please attach another sheet, if required

3. INFORMATION OF EDUCATION:
(Name of schools previously attended by applicant)

Schools attended

Year
commenced

SK HICOM

Year
completed

Qualifications
obtained

2000
2006

2005

SMK SEKYEN 27

2010

3A2B
3A-2B+2B3C+

POLITEKNIK SEBERANG PERAI

2011

2014

3.17

UNIVERSITY MALAYSIA PAHANG

2014

2019

3.25

4. EXTRA CURRICULAR ACTIVITIES

(Please provide information for the period from Form 4 onwards only)

No

1
2
3
4
5
6

Year

Position/Participation

Activity/Society/Sports

Level of participation
(School/ District/ State/
National)

2009
2010

GOLD MEDAL 4X400m

SPORT
SPORT

SCHOOL

BRONZE 4X400m

2010

BRONZE 1X400m

SPORT

SCHOOL

2012

DOUBLE PROMOTION

SPORT

POLYTECHNIC

2015

SCHOOL

SPORT
REFER TO ATTACHMENT AT BEHIND

(Please continue on another sheet, if required)

N5. APPLICANT IS CURRENTLY AN UNDERGRADUATE STUDENT:

(This section is applicable to undergraduates only)
UNIVERSITY MALAYSIA PAHANG
Name of institution/university:
Course of study: BACHELOR IN MECHANICAL ENGINEERING (HONS)
Duration of course (years): 4
Latest CGPA in semester/year:
Current year and stage of study: 2
Commencement date for current academic year: 07/09/2015

3.25

6. FAMILY PARTICULARS
Name of Parents or
Guardian

NRIC No

Tel/hp No.

Date of
birth

Occupation

Monthly
Income
(RM)

(Father/Guardian name)
CHINNASAMY A/L T.KAVANDAN

510731085045

0356144266

31/07/1951

RETIRED

0356144266

14/11/1958

HOUSE WIFE

1000
(SOSCO)

(Mother name)
SARASWATHY A/L LECTHUMANAN

581114085478

TOTAL Monthly Income

1000

Siblings
NRIC No or
Birth Cert No.

Name of Sibling

Date
of birth

Occupation/
Studying (Std/)

Monthly
Income

(Form/Tertiary)

(if any)

STUDENT
KLUIC

SHANMUGAM A/L CHINNASAMY

(Please continue on another sheet, if required)

7. ADMISSION GAINED* or APPLIED* FOR CURRENT ACADEMIC YEAR 2016/2017

No
1
2
3
4
5

Course
BACHELOR IN MECHANICAL ENGINEERING (HONS)

Name of Public or Private

University/College*
UNIVERSITY MALAYSIA PAHANG

Course Duration (Years)

4

(*delete where appropriate)

8. ANNUAL EXPENSES (estimate)

RM
2690

Annual tuition fees

Other compulsory fees
Board and lodging
Transportation
Textbooks
Miscellaneous pocket expenses

450
1350
400
350
550

TOTAL Annual Expenses

5790

9. REFEREES
(Please do not select immediate family members or relations)

Full name:

KAYALVILI D/O MUNUSAMY

NRIC No: 790826145492

Occupation: LABORATORY HEAD
Contact No: 0172530070
Address/State/Post code: LOT 579, BATU 7/4 ,JALAN KAPAR, KAMPUNG RAJA , 42200 KLANG SELANGOR DARUL EHSAN

Full name:

MOHANA ATHI D/O NARAYAN

NRIC No: 860622566050

Occupation: TECHINICIAN
Contact No: 0123245006
Address/State/Post code: G6, BLOK 34, TAMAN ALAM MEGAH SEKYEN 28, 40400 SHAH ALAM, SELANGOR DARUL EHSAN

10. STATEMENT OF PURPOSE

(Attach separate paper)

Write a statement indicating how the chosen course of study fits in with your career aspirations OR
outline reasons why you deserve this scholarship in not more than 200 words. (Attach separate paper)

11. MARRIED APPLICANT

Details of Spouse
Name of Spouse

NRIC No.

Age

Occupation

Monthly Income (RM)

Children
No.

Name

NRIC /Birth Cert. No.

Age

Studying(kgarten/std/form)

12. HOW DID YOU COME TO KNOW ABOUT THIS SCHOLARSHIP?

(Please select accordingly)

Advertisement Name of newspaper: _______________

Website
Friends
School teachers
Others (please specify)___________________________

13. TERMS AND CONDITIONS

The scholarship award is for the pursuit of a full-time diploma/first degree program at
institutions of higher learning in local public or private universities/colleges in Malaysia.
The value of each award is subject to the course taken and will not exceed RM9,000 per
academic year in public or private university/college. Each award will be for the minimum
period required to complete the course of study.
The scholarship award will be reviewed annually subject to academic performance and other
terms and conditions stipulated.
Successful candidates shall not at anytime during the course be in receipt of any other
scholarships, financial aid or award from other educational institutions or organizations
without the prior consent of YAYASAN WAH SEONG.
The offer of award is subject to the candidates successfully gaining admission to the
universities/colleges for the current academic year.
Successful candidates are required to sign a Scholarship Agreement and are deemed to be
aware of the terms and conditions of the scholarship award and the rules and regulations
governing the program.
YAYASAN WAH SEONG reserves the right to amend/modify the terms and conditions of the
Scholarship award from time to time as deemed appropriate.

14. DECLARATION
I hereby agree and consent to Yayasan Wah Seong (Yayasan) storing and processing my personal
data and the information given by me in the scholarship application form is correct and true to the best
of my knowledge. I hereby agree that Yayasan has the right to conduct any investigation against the
information provided by me in the scholarship application form. I fully understand and accept that, if at
any time after awarding the scholarship, it is found that a false declaration has been made on this form,
Yayasan has the absolute right to terminate my scholarship forthwith.
I have notified my family members (including my parents and siblings) of the contents of this
scholarship application form and I hereby confirm that my family members have consented to Yayasan
storing and processing their personal data given by me in this scholarship application form. I hereby
agree and consent to Yayasan storing and processing the personal data of my family members given
by me in this scholarship application form.

___________________
Signature of Applicant

_______________
Date

Successful short-listed candidates must provide the following documents during the preliminary
interview.
Original/Copy of academic transcripts that have been certified as True copies by the schools or
university/college from where the candidate graduated,
Letter of admission from the university or college, (if any)
Any other documents that candidates wish to submit to strengthen their application including
copies of articles written, reports of volunteer work, extra curricular certificates etc.

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