AMMA Foundation (061151-D)11th Floor, Bangunan Yee Seng, 15 Jalan Raja Chulan, 50200 Kuala Lumpur.Tel: 03-2070 1080 Fax: 03-2072 1080 www.ammafoundation.com.my

Study Loan Application Form

I. PERSONAL INFORMATION OF THE APPLICANT

a) Name :

b) NRIC No :

c) Date of Birth :

d) Citizenship :

e) Permanent Address :

f ) Correspondence Address :

g) Marital Status :

h) Profession :

i) Contact No- Home/ O�ce : Mobile :

j) E-mail address :

II. ACADEMIC QUALIFICATIONS OF THE APPLICANT

*Please furnish photocopies of all certi�cates

Level

STPM

SPM

Others

Grade Detailed Results

(as stated in NRIC)

III. COURSE DETAILS

a) Course applied for :

b) Date of Commencement :

c) Name of the Institution :

d) Duration of the Course :

e) Fee Structure & Related Expenses

e) Amount of Loan Required :

f ) Have you applied for any other loans? YES / NO

If yes, give details :

Particulars

Course fee

Food & lodging

Books

Others

Total

Annual Total

IV. PARENTS PARTICULARS

Note: If the assets are under loan, please state. Please enclose two months salary slips/EA form of parents.

V. FOR APPLICANT WHO IS EMPLOYED

a) Profession :

b) Organisation :

c) Address :

d) Contact No. :

e) Monthly Income :

ParticularsName

NRIC No

Address

Occupation

O�ce Address

Contact No.Monthly Income

Details of Assets

Father Mother

VI. FOR APPLICANT WHO IS MARRIED

a) Spouse’s Name :

b) NRIC No. :

c) Permanent Address :

d) Correspondence Address :

e) Profession :

f ) Monthly Income :

VII. DETAILS OF SIBLINGS

Name Occupation Marital Status Monthly Income

Monthly Financial Support to Parents (if any)

Age

VIII. GUARANTORS

Note: Immediate family members cannot stand as Guarantors, and all Guarantors must be below the age of 50.

IX. DECLARATION

We declare that the above information is true to the best of our knowledge.

Applicant’s Signature

Date:

Parent’s Signature

Date:

ParticularsName

NRIC No

Date of Birth

Address (home)

Tel (home/HP)

Occupation

Address (o�ce)

Tel (o�ce)

Monthly Income

Guarantor 1 Guarantor 2

X. RECOMMENDATION BY AMMA AFFILIATE

(Signature of authorised o�cial)

Name of O�cial :

Position in Organisation :

O�cial A�liate Stamp :

XI. FOR OFFICE USE ONLY

a) Recommended by Study Loan Committee

Signed by Chairman,Study Loan Committee

Name :Date :

b) Board’s Decision : Approved / Not Approved

c) Amount Approved :

d) Date of Approval :

e) Remarks, if any

(Signature of authorised o�cial)