SUPERB Application Form to Participate in the Business Challenge

Please complete this form and email it back to superb.application@teraju.gov.my

State your email subject as: SUPERB Application : <Your Idea Title>
You can also attach any relevant additional information.
The closing date for the 1st round of applications is on 21 February 2014, 5.30pm.

Idea Title :

Personal Details
Team Leader
Name : JIM LUQMAN HAKEMBIN HJ. MOHAMAD
Gender : MALE
Date of Birth : 14TH JULY 1981
MyKad Number : 810714-01-5875
Marital Status : MARRIED
Number of Children (if any) : 2
Language(s) Spoken : MALAY LANGUAGE AND ENGLISH
DIPLOMA IN TECH IN ELECTRICAL EQUIPMENT &
Education/Qualification : INSTALLATION TECH, 2002, MALAYSIA FRANCE INSTITUTE.
28-7, JALAN DAMAI, TANJUNG AGAS, 84000 LEDANG,
Home Address : JOHOR DARUL TAK’ZIM.
Mobile Number(s) : 0166177542
Email : jimluqmanhakem@gmail.com

I am a(n) Student <which institution and course?>

Employee
Professional
Unemployed <how long has it been?>
Entrepreneur <10 years>

Jim Haiery B. Mohamad: IT & Engineering

Haryaty Murni B. Mohamad: IT & Construction Company.
Family business background : Izaziah Morni B. Mohamad: Automotive Parts.

2002- May 2003(Kenseisha (M) Sdn. Bhd.) Junior

Previous employer(s) : Technician
Task: AutoCAD Drafter , ISO 9002 Documentation
Supervisory Maintainance Department,
Machine Troubleshooting,
Master & Jig Calobration,

2003-2004 : Direct Selling Business (Elken Sdn. Bhd.)

2003-2004 : Sri Nilam Budi Trading (Supply Coffee powder
“KENALI KOPI”)
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2004 : Techno-preneur MARA (Majlis Amanah Rakyat)-
Prima Consulting Malaysia
Nature of Business : (Engineering Business)
Duration : 24 months
Attachment with Tracoma Holding Berhad and Teguh
Timur Technology Sdn.Bhd.

Trachoma Holding Berhad : Marketing task for

Progressive Punching Machine and Injection Moulding.
Achivement: RFQ for Honda (M) Sdn. Bhd. and Hitachi
Aircondition (M) Sdn. Bhd.

Teguh Timur Technology Sdn. Bhd.

 From Waste to Wealth : Palm Oil Empty fruit
bunch (EFB) to paper pulp.
 Business proposal for FELDA & Felcra Berhad.
Achievement : Presentation proposal for FELDA Berhad.
Status: K.I.V

2006: Pineapple Ark Sdn. Bhd. (Managing Director)

 Biotech status company
 Non Disclosure Agreement with Malaysian
Institute for Nuclear Technology (Mint @ Malaysia
Nuclear Agency) (BioFertiliser with Enhance
Microbe)

2007-Present: Marvelous Point (Manager)

 Supplies computer parts

 Marketing for Nota Asia Sdn. Bhd.Multimedia
Development Corporation (MDeC) Soft skill ,
Undergraduate Skill Programme.(J2EE)
 Organised Defensive Riding & Driving Course
(Marshall) 2009-2012.
 Achievement: 20 Series of Marshall Course,
 Appearances on TV3, TV9 and TV1

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Personal Details
Team Member 1
Name : AHMAD BIN YUNUS
Gender : MALE
Date of Birth : 15TH JULY 1966
MyKad Number : 660715-01-5171
UNDERGRADUATE BUSINESS MANAGEMENT, 1989, MARA
Education/Qualification : INSTITUTE OF TECHNOLOGY
No. 24, JALAN MELOR 3, TAMAN KESANG BARU, 84000
Home Address : LEDANG, JOHOR DARUL TAK’ZIM
Mobile Number(s) : 019-6282101
Email :

I am a(n) Student <which institution and course?>

Employee
Professional
Unemployed <how long has it been?>
Entrepreneur <how many years or how many times?>

Family business background : <Please explain business of family members, if any>

1989-1993, MASS PRODUCTION ASST. MANAGER IN
JAPANESE ELECTRONIC COMPANY,
1995-2008, PRODUCTION PLANNING MANAGER CUM
WAREHOUSE & LOGISTIC MANAGER AT HARTA
PACKAGING BHD., PUBLIC LISTED COMPANY
. Main Duty- Planning, Execute and maintaining company
for production lean system,
ISO 9002 & 14000,
Supervise 3 teams of employees
1. Production Planning,
2. Warehousing,
3. Logistic.
4.
2008 – PRESENT, LEDANG WOODWORKS
Previous employer(s) : INDUSTRIES, MANAGER, WOOD PRODUCTS.

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 Team Member 2
Name :
Gender :
Date of Birth :
MyKad Number :
Education/Qualification :
Home Address :
Mobile Number(s) :
Email :

I am a(n) Student <which institution and course?>

Employee
Professional
Unemployed <how long has it been?>
Entrepreneur <how many years or how many times?>

Family business background : <Please explain business of family members, if any>

Previous employer(s) : <Please state designation and department>

Company (if already incorporated)

Company Name :
Company Number :
Company Address :
Company Shareholders : <Please state name and shareholding percentage>
<Please state name and shareholding percentage>
Company Directors :

Paid-Up Capital (RM) :

Date of Incorporation :
Years in Operation :
Nature of Business :
Revenue for 2013 :
Profit after tax for 2013 :

Please answer the questions below regarding your idea/product/solution:

1. Tell us your business idea in less than 200 words

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2. Why do you think it will work? What makes your business unique?

3. Which sector does your business fall into? Communications, Content & Infrastructure
Electronics & Electrical
Wholesale & Retail
Palm Oil & Rubber
Oil, Gas & Energy
Financial Services
Business Services
Healthcare
Agriculture
Education
Tourism
Other: <state other sector(s)>

4. Has this idea been pitched or presented to other Government agencies? If yes, which agencies?

5. How much did you invest your own money in this?

6. Tell us your team's experience and capability that makes you capable of delivering this project.
Please include relevant past projects.

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7. Who is your target market?

8. What would be your business model?

9. How much funds do you need and why do you need it?

Utilisation of funding Amount (RM)

TOTAL

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Declaration

Have you received any financial assistance from the Government before? ( Yes / No )

If yes, which Government agency, how much, for what type of project and state utilisation of funds

Please state which information provided in this application that you do not agree to be used for
the purposes of consolidation, analysis, preparing statistics, marketing, advertising and promotion
via television and/or other mass or social media

I, JIM LUQMAN HAKEM BIN HJ. MOHAMAD 810714-01-5875, hereby declare:

1. Acknowledgement

a) I acknowledge that the submission of this application does not create an obligation or
guarantee on the part of TERAJU to approve the application herein.

b) I hereby agree for TERAJU to process my personal data provided herein for the purpose of
this application.

c) I hereby acknowledge that while TERAJU will use reasonable effort to safeguard the
confidentiality of the information submitted in this application, TERAJU shall be entitled to:

i. disclose the information submitted herein to such persons involved in the evaluation
process of this application including without limitation TERAJU’s employees,
consultants, agents, advisors and/or such other persons as may be appointed by
TERAJU; and

ii. use any information submitted herein for the purposes of consolidation, analysis,
preparing statistics, marketing, advertising and promotion via television and/or other
mass or social media, and if I do not agree that any part of the information provided
herein can be used for such purpose, I should expressly identify such data and
highlight the same to TERAJU in advance in this application form.

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d) I further acknowledge that TERAJU considers all submitted applications as confidential and
treats all team matters accordingly. However, TERAJU cannot guarantee complete
confidentiality for proprietary matters. TERAJU is not responsible for any proprietary
information and/or intellectual property included in a submitted application. Ultimately, I
am solely responsible to protect sensitive materials.

2. True and Accurate

I hereby declare that all information furnished, or to be furnished, in connection with the Project
and this application does not contain any untrue statements and were honestly provided and
made upon due and careful inquiry and I have not omitted to state any fact(s), the omission of
which makes such statements misleading.

3. Personal Data Protection Statement

I agree that, with regard to the personal data relating to the other individual(s), which are
provided to TERAJU in this application form, I have obtained the following from such individual(s):

(a) his/her consent for TERAJU to process his/her personal data provided in this application
form, and any other additional personal data which may be further provided to TERAJU in
connection with this application form;

(b) his/her confirmation that his/her personal data provided are complete and accurate;

(c) his/her acknowledgment that he/she is entitled to obtain access to and to request
correction of the personal data provided to TERAJU and that he/she can request TERAJU to
cease processing his/her personal data. For this purpose, he/she should contact TERAJU,
either by sending an email to superb.application@teraju.gov.my or by sending a letter to
TERAJU at Level 5, Surian Tower No. 1, Jalan PJU 7/3 Mutiara Damansara, 47810 Petaling
Jaya, Selangor Darul Ehsan; and

(d) his/her consent that TERAJU may disclose his/her personal data to:

i. any TERAJU vendor(s), contractor(s) and/or outsourcing company(ies) engaged by

TERAJU, for purposes in connection with this application form; and/or

ii. Government authorities, agencies and and/or any other regulatory body, to the
extent that the Government or other authorities, agencies and/or any other
regulatory body need to know, or as permitted by applicable laws and regulations.

I further agree that in any event TERAJU receives any request by any data subject for withdrawal
of consent to process any personal data provided herein, TERAJU has the right to treat this
application as null and void.

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BY SUBMITTING THIS APPLICATION FORM TO TERAJU, I HEREBY
CONFIRM MY DECLARATION, ACKNOWLEDGEMENT AND
AGREEMENT ON ALL THE INFORMATION GIVEN AND TERMS
STATED ABOVE