CONFIDENTIAL

2008 SCHOLARSHIP APPLICATION FORM

SHELL MALAYSIA

Rev. 1/2008

1. 3.
4.

The scholarship is awarded to Malaysian students for pursuing full-time undergraduate studies (1st degree course) tenable at recognized universities in Malaysia or overseas. 2. Students who have completed their STPM/A-Levels/Foundation Year/Diploma or currently in their final semester of Matriculation studies or in the University (IPTA/IPTS) are eligible to apply. Please complete the form in BLOCK LETTERS. If the space is insufficient, please give further information on a separate sheet of paper. INCOMPLETE and LATE application will be rejected.

Please affix your recent passport-sized photograph.

5. 6. 7. 8.

If you do not receive any reply from us by 31st March 2008, your application is therefore considered unsuccessful. *Please delete whichever is NOT applicable. For those applicants with no Internet facilities, please send your duly completed form directly to: SCHOLARSHIP COORDINATOR, Bangunan Shell Malaysia, 2nd Floor, Changkat Semantan, Damansara Heights, 50490, Kuala Lumpur.

APPLICATION TYPE []:

(The Company reserves the right to change the Application Type.)

Malaysia 1. PERSONAL PARTICULARS NAME (as per your Identity Card)

Overseas

GENDER : NRIC NO. AGE

Male/Female* ETHNIC :

Bumi/Non-Bumi*

: _____years old

RACE : ________________________ DATE OF BIRTH :_____________________________________________ STATE OF ORIGIN:

RELIGION:_________________________ Sabah/Sarawak/Others*____________HOMETOWN:

PREFERRED PLACE OF INTERVIEW: KUCHING/SIBU/MIRI/KOTA KINABALU/TAWAU/SANDAKAN/LABUAN/Kuala Lumpur/Others (Your selected location should be nearest to your current hometown. All travel expenses incurred will be on the applicants personal account. The Company reserves the right to change the location of interview.) CORRESPONDENCE ADDRESS contact nos. are active.) : (Please ensure that your address, email and Tel. No. HP No. E-Mail : ______________________________ : ______________________________ : ______________________________ :_____________________________

_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Any physical disability (eg. sight, hearing, speech) :

Post Code

Any previous illness/operation :

2.

FAMILY PARTICULARS
Particulars Name Occupation Basic Salary/Income (RM) Employer Race Ethnic Bumiputra/Non-Bumiputra* Bumiputra/Non-Bumiputra* Father Mother

Sarawak/Sabah/Others* Sarawak/Sabah/Others* State of Origin Note: Please produce a supporting document if your parent do not have a payslip (applicable to retiree, pensioner, fisherman, farmer, unemployed, amah/baby-sitter), handicap, separated, divorced or deceased.

FOR OFFICIAL USE

Diploma/Matrix/Fdn Yr/Undergraduates GPA/CGPA : .....................

CONSIDERED [Meeting minimum criteria] SHORTLISTED [Invitation for Interview]

Parents Income : <RM3K/>RM3K ................................................... ...................................................

LEVEL/SEMESTER...................:

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Do you have any brother or sister currently holding the Shell Scholarship? YES/NO* If yes, please complete the following: Name Relationship Relatives working in Shell Relationship Institution

Name

Dept. & Office Contact No.

3.

EDUCATION QUALIFICATION
STPM/A-LEVEL* YEAR : 200_____ DIPLOMA/MATRIX/FOUNDATION YEAR/UNDERGRADUATES* OTHERS: .............................. (please specifiy) School (for STPM) College/University Course Intake Year Course Duration : ...................................................................................... : ...................................................................................... : ...................................................................................... : 200........ : [3]/[4]/[5]/OTHERS*......................YEARS (please specify) /20

Please [] your highest qualification.

LEVEL:YEAR

[1]/[2]/[3]* [1]/[2]/

SEMESTER : [FINAL]*

Expected Completion (Mth/Yr)..............................:.............

Please state your choice of courses that you intend to apply. If you are already in the university, please ignore this section. CHOICE COURSE 1ST 2ND

4.

EXTRA CURRICULAR ACTIVITIES (2004-2006)

Please use separate sheet if space is insufficient. CLUBS/SOCIETIES/OTHERS YEAR

ACTIVITIES

POSITION HELD (Please refer to the list below)

REPRESENTED : House; School; District; Division; State; National POSITION HELD : Chairman; President; Vice/Dep. President/Chairman; Captain/Leader; Treasurer; School Prefect; Secretary; Assistant; etc.

5.

SPECIAL AWARDS RECEIVED

6. OTHER INFORMATION
Are you currently receiving any financial assistance or sponsorship from other institution, fund or foundation? YES/NO* If YES, please give details: Institution/Fund/Organisation/Foundation (eg. JPA, MARA, PETRONAS, PTPTN, etc.) Year Amount (RM) 1) 2)

7. DECLARATION
I declare that all the above particulars are true and correct. I understand that, should I accept a scholarship and any of the above information is found to be false, the scholarship will be held liable to repayment of monies expended. I also understand that the completion of this form does not commit the Shell Scholarship Fund to assisting me in any way. I enclosed herewith my certified copy of the supporting documents [ ]. (1) (2) (3) Birth Certificate & Identity Card Results STPM/Matrix/Foundation/Diploma/Year 1 School Testimonial (Surat Akuan), Certificates of Achievements, School Co-Curricular Activities, etc. 2 latest semester results (applicable to those currently in the Matriculation/Foundation Year/Diploma/University) Letter of Offer from the University (applicable to those currently in the University) Parents' Identity Card, 2-month Latest Salary Slip/Income Tax Statement (Form J) or any other supporting document of my parents status. Date____________________________:

(4) (5)
(6)

Applicant's Signature:_________________________________

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