5. All fields are compulsory and MUST be filled up. For fields that do not apply to you, please put as N/A (not applicable).

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Cameron Joel Phelps
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1 GREAT EASTERN SUPREMACY SCHOLARSHIP AWARDS APPLICATIONS Instructions to Applicants 1. Read the instructions carefully. Incomplete application forms and applications that do not comply with the requirements can result in unsuccessful application. 2. All applications are to be sent via to with the subject "Supremacy Scholarship Awards Application - YOUR FULL NAME (IC Number) (as per your IC). E.g. Supremacy Scholarship Award Application ALI BIN ABU ( ) 3. To complete this form, please download it, fill it up (you can type on the PDF document), save it, and send it to us to the address stated above. Please complete Section 9 Declaration by printing the page out and signing at the appropriate column. Upon signing you would need to send the scanned copy of Section 9 to the address stated above together with the application form. 4. Applications need to be completed in English. 5. All fields are compulsory and MUST be filled up. For fields that do not apply to you, please put as N/A (not applicable). 6. Applicants MUST ONLY attach these items in their application: (all documents can be in PDF, DOC, GIF or JPEG formats) Recent passport sized photo Scanned certified true copy of Identification card (front & back) Scanned certified true copies of academic certificates & transcripts (STPM / UEC / A-Levels / SAM / CPU / Matriculation / Diploma / etc.) **Please note: Applicants are required to bring original document of the above and other relevant documents if they are further shortlisted. 7. All documents that are not in English, Bahasa Malaysia or Mandarin, MUST be translated and certified before submission to us. 8. All applications MUST reach us by 30 April ONLY successful applicants will be notified via and / or telephone. Students are required to enclose the following documents (certified true copy) with your duly completed scholarship application form before returning to Great Eastern Life for processing 1 Duly completed Application Form 2 My Kad (identification card) 3 Recent passport sized photo 4 STPM, UEC, A-Levels, SAM, CPU. Matriculation, Diploma certificates or its equivalent Please ensure the application form is complete with the above documents before you mail your application to us for processing. Applications with incomplete documentation will not be considered. Page 1 of 6

2 GREAT EASTERN LIFE ASSURANCE MALAYSIA BERHAD APPLICATION FOR SUPREMACY SCHOLARSHIP AWARD Photograph COURSE OF STUDY: 1) (In order of preference) 2) 3) UNIVERSITIES APPLIED TO: 1) 2) 3) Important: The form must be fully completed. State Not Applicable for sections / areas which do not apply to you SECTION 1 PERSONAL PARTICULARS Full Name: Gender: Permanent Address: Street Name 1: Street Name 2: Post Code: City: State: Contact No.: Home Tel. No.: Address: Place of Birth: My Kad No. ( ): SECTION 2 EXTRACURRICULAR ACTIVITIES (Last 2 years only) Society or Club Position Held Duration List of Activities of Society or Club Sports Participated Level Represented (School/District/State/ Country) Date Achievements (If any) Important: If you are currently studying in a University, kindly refer to Section 6 of this form Page 2 of 6

3 SECTION 3 EDUCATION A) Sijil Pelajaran Malaysia SPM or equivalent School: Year of Exam: Please list all subjects Subjects Grade Subjects Grade Bahasa Malaysia English Mathematics Sejarah Pendidikan Islam/Moral B) Sijil Tinggi Pelajaran Malaysia STPM/A-Levels/Matriculation or equivalent School: Year of Exam: Please list all subjects Subjects Grade Subjects Grade C) Other post STPM qualifications Qualification Obtained Examining Body Year Grade / CGPA Obtained Please attach certified true copies of your result slips or certificates along with the application form SECTION 4 PERSONAL ACHIEVEMENTS Please list any information that you wish to bring to the attention of the Scholarship Selection Committee (in not more than 50 words). SECTION 5 FAMILY PARTICULARS List out below the names of your father, mother, brothers and sisters. Please use separate sheet, if necessary. Full Name Relationship Age Occupation Salary (RM) 1) Type of house you are presently living in? Own house/rented/others* 2) Is either of your parents involved in business? Yes/No * If yes, what type of business 3) What assets/property (ies) other than you family home, do your parents own, please list below: Page 3 of 6

4 Value Assets/Property(ies) 1) 2) 3) 4) 5) * Delete where not appropriate If you are shortlisted, you will be required to bring along original documents to verify the above information. Please list the Insurance Policy(s) that you or your parents currently own with Great Eastern Life: Name of Policyholder Policy No. Date of Issue 1) 2) 3) 4) Name of Agent who sold you the Policy (if possible) SECTION 6: ONLY FOR APPLICANTS PRESENTLY STUDYING AT UNIVERSITIES Current university: Year admitted: Course of study: Major: How is your study being financed currently? Self/ Loan/ Scholarship (Delete where not applicable) If you are receiving loan/ scholarship, please state the source: and amount: SECTION 7 BRIEF EXPLANATION a) Tell us why you deserve this scholarship and how you can contribute to Great Eastern Life (in not more than 50 words). b) Where did you find out about our supremacy scholarship programme? (Please tick at the relevant box/es) 1. Social Media (Please specify: ) 2. Website ( ) 3. Newspapers (Please specify: ) 4. Family/friends 5. Great Eastern Life Planning Advisor/ Great Eastern Life Agent 6. Others (Please specify: ) Page 4 of 6

5 SECTION 8 DATA PROTECTION/ DATA PERIBADI We, Great Eastern Life Assurance (Malaysia) Berhad and our group of companies will use the information and documents which is provided to us on and in connection with this application for scholarship award, together with other information and documents we may obtain about you, to assess your suitability for a scholarship award from us, for administration and management purposes and for statistical analysis. We may disclose your information to companies within our group of companies, our service providers and agents for these purposes. Your information is necessary to us. If you do not provide all the information requested herein or if you do not consent to the use of such information in the manner set out herein, the Company may not be able to award you with our scholarship. If your application is unsuccessful, we will keep your information for a reasonable period in accordance with legal requirements and for administration purposes. If you provide us and/or our service providers and agents with any information about your physical and mental health, religious beliefs, or criminal convictions (if any), you consent to our processing such information for the purposes described above. You have the right to ask for a copy of the information which we hold on you and which is subject to the applicable data protection laws in Malaysia (for which we may charge a reasonable fee for access) and to correct any inaccuracies in your information. However, the information that we may release to you does not include information containing personal data of another data subject which includes, but is not limited to, the assessments and/or views of our interviewees or assessors of you. You also consent to our transferring your information to the regional offices of the Great Eastern Holdings Limited group of companies ( Great Eastern Group ), which may not provide the same level of data protection as Malaysia, if necessary for the purposes described above. If we do make a transfer we will take all reasonable steps to ensure that your information is protected If you would like to make the above request or have any inquiry or complaint (such as limiting the processing of certain information), you may contact our Privacy Officer at We may also contact you if other scholarship award intakes arise in the future which we think may be suitable for you, either with us or with other companies in the Great Eastern Group. If you do not wish us to contact you for this purpose, please tick this box. Kami, Great Eastern Life Assurance (Malaysia) Berhad dan kumpulan syarikat kami akan menggunakan maklumat serta dokumen yang diberi, berkenaan dan berhubung dengan permohonan untuk tajaan biasiswa, berserta maklumat dan dokumen lain yang diperoleh berkaitan anda, untuk menilai kesesuaian anda menerima tajaan biasiswa daripada kami, untuk tujuan pentadbiran, pengurusan serta analisa statistik. Kami mungkin mendedahkan maklumat anda kepada syarikat di bawah kumpulan syarikat, penyedia perkhidmatan dan ejen kami bagi tujuan ini. Maklumat anda adalah penting untuk kami. Jika anda tidak menyediakan semua maklumat yang diperlukan dalam borang ini atau jika anda tidak membenarkan maklumat tersebut digunakan seperti dinyatakan dalam borang ini, Syarikat mungkin tidak dapat memberi tajaan biasiswa kepada anda. Jika permohonan anda tidak berjaya, kami akan menyimpan maklumat anda untuk suatu tempoh tertentu, mengikut keperluan undang-undang dan tujuan pentadbiran. Jika anda memberikan kami dan/atau penyedia perkhidmatan serta ejen kami berkenaan sebarang maklumat berkaitan keadaan fizikal dan kesihatan mental, kepercayaan agama atau sabit kesalahan (jika ada), anda telah membenarkan kami untuk memproses maklumat tersebut bagi tujuan yang dinyatakan di atas. Anda berhak meminta salinan maklumat berkaitan anda yang dipegang oleh kami dan tertakluk kepada undang-undang perlindungan data yang berkaitan di Malaysia (kami mungkin mengenakan bayaran yang berpatutan untuk melakukan capaian) serta membetulkan sebarang maklumat yang tidak tepat berkaitan anda. Namun, maklumat yang kami keluarkan kepada anda tidak mengandungi data peribadi berkaitan perkara lain yang termasuk serta tidak terhad kepada penilaian dan/atau pandangan penemu duga atau penilai kami ke atas anda. Anda juga membenarkan kami untuk memindahkan maklumat anda kepada syarikat serantau di bawah kumpulan syarikat Great Eastern Holdings Limited ( Kumpulan Great Eastern ), yang mungkin tidak memberi perlindungan data yang setara seperti di Malaysia, jika perlu, untuk tujuan yang dinyatakan di atas. Sekiranya kami melakukan pemindahan data, semua langkah yang munasabah akan diambil bagi memastikan maklumat anda dilindungi. Jika anda ingin membuat permohonan di atas atau mempunyai sebarang pertanyaan atau aduan (seperti mengehadkan pemprosesan sesetengah maklumat), anda boleh menghubungi Pegawai Privasi Syarikat kami di Kami mungkin menghubungi anda jika terdapat tawaran tajaan biasiswa lain pada masa hadapan yang mungkin bersesuaian untuk anda, sama ada dengan kami atau syarikat lain dalam Kumpulan Great Eastern. Jika anda tidak mahu dihubungi untuk tujuan ini, sila tandakan kotak berikut. Page 5 of 6

6 SECTION 9 - DECLARATION I, I/C No. hereby certify that all statements made in this application are true and complete to the best of my knowledge and have not withheld any information which might influence the consideration of this application. I understand that any misrepresentation / false declaration or omission will be sufficient cause for cancellation of consideration for scholarship. I also authorize any investigation of the above information for the purpose of verification. Application Date Applicant s Signature FOR GREAT EASTERN LIFE USE Eligible: Not Eligible: Page 6 of 6

REGISTRATION FORM SYSTEMATIC REVIEW AND META-ANALYSIS WORKSHOP 26 TH to 28 TH October 2015 (3 DAYS) Selangor, Malaysia. REGISTRANT DETAILS

REGISTRATION FORM SYSTEMATIC REVIEW AND META-ANALYSIS WORKSHOP 26 TH to 28 TH October 2015 (3 DAYS) Selangor, Malaysia. REGISTRANT DETAILS Salutation Full Name Institution/Company Department Contact Address