FOR OFFICE USE

Date Received:

Reference No:

Processed By:

MOSTI

CONTENT INDUSTRY DEVELOPMENT FUND

(eCONTENT FUND)

APPLICATION FORM

Please read the Application Guideline before completing this form.

This form must be used for submitting a formal application for eContent Fund. All information
required in the application form must be submitted. Incomplete application will not be processed.

Applicants must submit the completed documentation through e-mail to: econtent@mosti.gov.my
(using Microsoft Word) AND 2 hard copies send to the following address:-

The Secretary-General,
Ministry of Science, Technology and Innovation (MOSTI),
Level 5, Block C5, Complex C,
Federal Government Administrative Centre,
62662 Putrajaya, Malaysia.
(Attn: eContent Fund Secretariat, ICT Policy Division)

Tel : 603-8885 8854

Fax : 603-8888 4328

http://www.mosti.gov.my

ALL INFORMATION PROVIDED IN THIS APPLICATION

WILL BE TREATED AS CONFIDENTIAL

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1.0 APPLICANT DETAILS

Please fill in either 1.1 or 1.2 whichever is relevant.

1.1 INDIVIDUAL

INDIVUAL DETAILS

1.1.1 Name :

1.1.2 IC Number Old: New:

1.1.3 Race :

1.1.4 Religion :

1.1.5 Status : Bumi / Non Bumi

1.1.6 Address as in IC :

1.1.7 Corresponding Address :

1.1.8 Tel. No. / Mobile :

1.1.9 Fax No. :

1.1.10 E-mail :

EDUCATION DETAILS

1.1.11 Highest Level of Education :

1.1.12 Name of School / Institution :
1.1.13 Field of Study :
1.1.14 Year of Completion / Graduation :

EMPLOYMENT DETAILS (IF APPLICABLE)

1.1.15 Employer :

1.1.15.1 Name :

1.1.15.2 Address :

1.1.15.3 Tel. No. :

1.1.15.4 Fax No. :

1.1.16 Designation :

1.1.17 Period of Employment :

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1.2 COMPANY

COMPANY DETAILS

1.2.1 Company Name :

1.2.2 ROC Number :

1.2.3 Date of Incorporation :

1.2.4 Company Classification : Enterprise / SME

1.2.5 Core Business :

1.2.6 Authorised Capital :

1.2.7 Paid up Capital

1.2.8 Registered Address:

1.2.9 Corresponding Address :

1.2.10 Business Tel No. :

1.2.11 Fax No. :

SHAREHOLDING DETAILS

1.2.12 Share Holding Structure : Bumiputera : % Non Bumiputera : %

1.2.13 Shareholders
Name Nationality No. of Shares ( % )

1.2.14 Director Details

Name IC / passport Nationality

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1.2.15 Contact Details
1.2.15.1 Name
1.2.15.2 Designation
1.2.15.3 Tel. No. : 1.2.15.4 Mobile No :

1.2.15.5 Email Address : 1.2.15.6 Fax No. :

2.0 PROJECT OUTLINE

2.1 PROJECT PROPOSAL

2.1.1 Type of Project : Social

Commercial

2.1.2 Focus area under which your proposal falls under:

Entertainment

Education and Training

Culture and Heritage

Information Based Content (e.g MyGfL)

2.1.3 Technology implementation in respect of the proposal (whichever is applicable) :

Animation
TV Series Feature Film Mobile / Hand held

Games
PC Online Console Mobile / Hand held

Simulation / Virtual reality

Portal / Web based

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2.2 PROJECT INFORMATION

2.2.1 Project Title :

2.2.2 Project summary (Not more than three (3) paragraphs; one (1) page ):

2.2.3 Project benefits / impact to the nation (Not more than three (3) paragraphs; one (1) page ):

2.2.4 Project deliverables / KPI

2.2.5 Project partners (If applicable):

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2.2.6 Project Costing :

2.2.6.1 Total Project Cost (RM)

2.2.6.2 Total Fund Requested (RM)

2.2.7 Project Timeline :

2.2.7.1 Start Date :

2.2.7.2 End Date :

2.2.7.3 Deliverables milestone by timeline :

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3.0 DECLARATION BY APPLICANT

I hereby certify that:

a. I have read, understood and agreed to abide by the ApplicationGuidelines;

b. The information provided in this application, including attachments, is true and correct to the best of my
knowledge;

c. I understand and accept that the Ministry of Science, Technology and Innovation may use the Project
information as described in Section 2.0 for public promotional purpose of the eContent Fund;

d. The Company is free from any litigation pertaining to the proposed project in Malaysia and overseas;
and

e. MOSTI reserves the right to withdraw approval given based on false information submitted by applicant.

Applicant Organization Certification

Name: I/C No. / Passport No.:

Designation: Signature:

Date:

Company/Individual Chop:

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4.0 DECLARATION BY COMMISSIONER OF OATH

I hereby certify that:

a. Particulars about the applicant as stated in Section 1.0 Applicant Details is true and correct to the best of
my knowledge.

Commissioner of Oath Certification

Name: I/C No. / Passport No.:

Designation: Signature:

Date:

Company Chop:

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 CHECKLIST FOR SUBMITTING APPLICATION

(Please tick [ ] appropriate box) [ ] (Official Use)

1. Covering Letter signed by applicant

2. Form 9 (Company Act,1965)
3 Form 24 (Company Act,1965)
4. Form 49 (Company Act,1965)
5. Memorandum & Articles of Association
6. A complete Project Proposal
7. Letter of Consent from Technology License / Patent Owner (if applicable)
8. Work schedule
9. Payment Schedule by deliverables
10. Business plan detailing the commercial potential of the project output (if
applicable)
11. Itemized costing of the Project Proposal
12. Declaration that the applicant is SME, not a public listed company / government
agency / research institute / university or its subsidiary

13. Patent search results

14. Declaration Letter from Jabatan Pemegang Harta that the Directors and
Shareholders of the Companies are not ‘undischarged bankrupt’

15. Ready Contract or Letter of Award for the proposed project (if applicable)
16. One softcopy of completed application form through email
17. Two (2) copies of completed application form

Checked by:
____________________
Date:
____________________

NOTE: Incomplete application will not be processed.

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