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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)
