Scholarship
Excellence Undergraduate Scholarship Form
Your Desired Scholarship Programme
CURRENT / PREFERRED UNIVERSITY*
CURRENT / PREFERRED FIELD OF STUDY*
*Disclaimer: The selection of field of study and university must correspond to the programme requirements within the Yayasan Sime Darby website.
FULL NAME (AS PER NRIC)
NEW NRIC NO.
Gender
AGE
Race
Marital Status
CONTACT DETAILS
MOBILE PHONE NO.
E-MAIL ADDRESS
LOCATION OF RESIDENCE
TOWN / CITY
STATE
Father / Guardian 1's Details
FULL NAME (AS PER NRIC)
NEW NRIC NO.
RELATIONSHIP WITH CANDIDATE
MOBILE PHONE NO.
E-MAIL ADDRESS
EMPLOYMENT STATUS
OCCUPATION
MONTHLY GROSS INCOME (RM)
Status
MOTHER / Guardian 2's Details
FULL NAME (AS PER NRIC)
NEW NRIC NO.
RELATIONSHIP WITH CANDIDATE
MOBILE PHONE NO.
E-MAIL ADDRESS
EMPLOYMENT STATUS
OCCUPATION
MONTHLY GROSS INCOME (RM)
Status
Parents' / GUARDIANS' details
For divorced / REMARRIED PARENTS, please state which parent is financially supporting the candidate
LATEST EXAMINATION RESULTS
INSTITUTION / SCHOOL NAME
YEAR
EDUCATION LEVEL
RESULT (CGPA / NO. OF A)
NAME OF AWARD / ACHIEVEMENT / COMPETITION
YEAR
LEVEL
NAME OF CLUB / SOCIETY
YEAR
LEADERSHIP POSITION
Have you ever been charged or convicted for the violation of any law, excluding minor traffic offences?
Have you ever been charged of drug abuse or any other illegal substance under Malaysian law?
Are you diagnosed with any illnesses, diseases or disorders?
Item 1 - 5 are compulsory. The supporting documents are to be uploaded in 1 PDF file (Max. size 3MB)
  1. Copy of applicant's NRIC,
  2. Copy of recent examination result,
  3. Copy of father's / guardian's pay slip / income declaration / EA form / pension statement,
  4. Copy of mother's / guardian's pay slip / income declaration / EA form / pension statement,
  5. Copy of 3 latest co-curricular activity / society / club certificates, and
  6. Copy of parents' divorce certificate / death certificate (if any)
IMPORTANT NOTE: These documents should be combined in a single PDF file with a total size not exceeding 3MB.
SUPPORTING DOCUMENTS
**Personal Data Protection Act Disclaimer**

Your personal data will be processed in accordance with Personal Data Protection Act 2010. Please visit www.yayasansimedarby.com for more information. Thank you.

Data peribadi anda akan diproses mengikut Akta Perlindungan Data Peribadi 2010. Sila layari www.yayasansimedarby.com untuk maklumat lanjut. Terima kasih.
Thank You for Your Submission.
Rest assured that we will be in touch with you soon.
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Last Updated:
29 Feb 2024
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