KUMPULAN WANG BIASISWA TAN SRI MANICKAVASAGAM
(Founded in 1972 – Registration No: 1101, Selangor) Tingkat 3, Menara Manickavasagam, No. 1 Jalan Rahmat, 50350 Kuala Lumpur. Tel: 03-40400700 Fax: 03-40415681 Email: kwbtsm@gmail.com

APPLICATION FOR STUDY LOAN

Applicants Passport Size Photograph

APPLICANT'S PARTICULARS
Full Name as Appearing On Identity Card: _______ Identity Card No: __________ ________ Permanent Address: __________________ ___________ Citizenship : ___________ ______ ___ _________________________________________________________ ______________________________________________________________

_________________________________________________________________ __________________________________________________ Marital Status: ___________ Place of Birth: ___________ Email Address: _______ ____________ ________ ___________

_____________________ ________________ ___ _________________ __ _

Date of Birth : ___________

Contact Number: __________ ________

UNIVERSITY / COLLEGE DETAILS
University / College: _________ ______________________________________________________________________________

Address: __________________________________________________________________________________________________
___

_______________________________________________________________________________________________

Faculty / Course: ____________________________________________________________________________________________ Year of Study (Current) : ___________ How do you get to know about KWBTSM? _ Earlier Loan If Any, From ___ ______________ Duration of Course: _____ ________ __ _____ ___ ______________ ______________ ____________

KWBTSM to you? Yes / No: ________ If Yes, state Amount: ___

____________

Other Scholarship / Bursaries / Loans - Applied for / Approved: ________ ____

FEES STRUCTURE
Total fees for Course: RM _____ Total amount needed: RM _ Other Expenses (Including food, transportation & etc): RM __ __ _

CONTRIBUTION FROM OTHERS TO APPLICANT’S (RM) PARENTS / GUARDIAN / FAMILY
RM

RELATIVES / FRIENDS
RM RM

PTPTN
RM

SCHOLARSHIP
RM

OTHER LOANS

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APPLICANT’S PARENTS / GUARDIAN’S PARTICULARS DETAILS
Name (as per I/C)

FATHER

MOTHER

GUARDIAN

Permanent Address

Occupation

Place of Employment & Address

Income (per month)

Telephone No

Income of Applicant's Parents / Guardian from Other Sources: _________

____ Amount Per Month: _________

_ _______

APPLICANT’S HUSBAND / WIFE PARTICULARS DETAILS
Name (as per I/C) Permanent Address Occupation Place of Employment Income (per month) Telephone No

HUSBAND / WIFE

PROPERTY OWNED BY APPLICANT’S PARENTS / GUARDIAN (MOVABLE AND IMMOVABLE) NO No DETAILS OF PROPERTY ADDRESS VALUE INCOME DERIVED PER MONTH

APPLICANT’S PARENT’S DEPENDENTS OTHER THAN APPLICANT

NO

No

NAME

AGE RELATION TO PARENTS / GUARDIAN

SCHOOLING / COLLEGE

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SELF SUPPORTING BROTHERS / SISTERS OF APPLICANT’S (INCLUDING BROTHERS / SISTERS IN LAW) NO NAME OCCUPATION INCOME PER MONTH MARITAL STATUS NO. OF CHILDREN LIVING WITH PARENTS AMOUNT CONTRIBUTION OF APPLICANT

State Briefly Any Other Reasons In Support Of This Application:

___

__________ ____ _

____ _

___

__________________________________ _____________________________________ _ _

Please name two Referees who are not related to you and to whom reference may be made for a report about your circumstances:

DETAILS
Name (as per I/C) Permanent Address

REFEREE 1

REFEREE 2

Occupation Place of Employment Income (per month) Telephone No

The Surety must be a person unrelated to the Applicant and acceptable to the Board with a regular income of not less than $1,500/- per month:

DETAILS
Name (as per I/C) Relationship to Applicant Identity Card No Permanent Address

SURETY 1

SURETY 2

Occupation Place of Employment Income (per month) Telephone No

_________________________

_________________________

Signature of Surety Date:

Signature of Surety Date:

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Declaration by Applicant: I declare that all particulars given herein are true and complete.

_________________________

Applicant's Signature

Date:

Declaration by Parents / Guardian: I declare that to the best of my knowledge, all the particulars given by the Applicant, who is my son/daughter, are true and complete.

______________________
Parents / Guardian Signature

Date:

Kindly take note that you are required to send your application form together with your supporting documents for our needful action. DOCUMENT REQUIRED
Student I/C copy Birth Certificate copy Student 1 Passport Size Photo Student ID Card ( Matric Card ) copy SPM / STPM / SPV / Foundation / Diploma / Others Certificate copy Offer Letter copy Applicant Parents I/C copy and pay slip Applicant Parents current three month pay slip Statement of Account copy (Repayment Payee Account) Sureties I/C copy (2 Person) Sureties current three month pay slip (RM 1,500 above) (2 Person)

Tick ( / )

Tick ( x )

* All document to be certified from any group of professional.

FOR OFFICE USE ONLY: Interview Date: Interviewed By: Amount Approved: Amount of Repayment: Checked By: Remarks:

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