COURSE applying for: FULL NAME AS IN PASSPORT: Surname/Family name: Given Names: Sex Gender: Date of birth: Place of birth: Birth Certificate number: Marital status: Race: Nationality: Religion: Occupation: Passport number: Passport issued by: Passport issued date: Passport expiry date: At this time are you presently physically in Singapore? Disembarkation/Embarkation WHITE CARD Barcode number: Date of entering into Singapore: Number of Days allowed to stay in Singapore? Date of expiry of Visa: Do you need extension of Visa / SVP? Phone numbers: Home Mobile Office Overseas address (in last 5 years) Singapore address: Do you have PROOF BY DOCUMENTS that you or your parents or siblings have more than S$10,000 IN SAVINGS OR FIXED DEPOSITS & they are willing to support your education in Singapore e.g. Bank Statements, Employment Letters, P/L statements,etc

1. ELEMENTARY EDUCATION Name of School attended: Language of instruction: From ddmmyy: To ddmmyy: Country/location of School: Highest Education Title attained: Certificate number: Note: Certificate & transcript details required 2. SECONDARY EDUCATION (a) Name of School attended: Language of instruction: From ddmmyy: To ddmmyy: Country/location of School: Highest Education Title attained (b) Name of School attended: Language of Instruction: From ddmmyy: To ddmdmyy: Country/Location of School: Highest Educational Title attained: Note: Certificate & transcript details required TERTIERY EDUCATION Name of School/College/U attended: Language of instruction: From ddmmyy: To ddmmyy: Country/location of School/College/U: Highest Education title attained Note: Certificate & transcript details required Other Qualification/Skills: (Pls list below)

(a) Name of Company: Location of company: Period worked: From ddmmyy To ddmmyy: Job title/ Nature of duties Salary per month: (b) Name of Company: Location of Country of Company: Period worked: From ddmmyy To: ddmmyy: Job title/Nature of duties Salary per month: (c) Name of Company: Location of company: Period worked: Fr:ddmmyy To ddmmyy: Job title/Nature of duties Salary per month: (d) Name of company: Location of Country of Co: Period worked: Fr ddmmyy To: ddmmyy Job title/Nature of duties Salary per month: REPEAT IF NECESSARY

(a)Father's name: Father's date of birth: Nationality of father: SC/SPR/EP/SP/WP number: Step-parent's name: Step-parent's date of birth: Nationality of Step-parent: SC/SPR/EP/SP/WP number: 2. Mother's name: Mother's's date of birth: Nationality of mother: SC/SPR/EP/SP/WP number: 3. Spouse's name: Spouse's date of birth: Nationality of spouse: SC/SPR/EP/SP/WP number: 4. (a) Sibling's name: Sibling's date of birth: Nationality of sibling: SC/SPR/EP/SP/WP/ number: 4.(b) Sibling's name: Sibling's date of birth: Sex of sibling: Nationality of sibling: SC/SPR/EP/SP/WP number: REPEAT IF NECESSARY

I the applicant certify that the above information furnished by me is true and correct to the best of my knowledge. I understand that misrepresentation or falsification of information is sufficient ground for rejecting or rescinding my application. If accepted as a student, I will comply with all conditions and regulations of the School and I ensure payment of all relevant fees and charges. Signed by the Applicant........................................... Countersigned by parent/guardian if under 21 ........................................................................

Please attach supportive documents below:
Passport page with photo
Recent p/p size photo 400 x 514 pixel
1st Highest Edu Cert
Marks Result Transcript
2nd Highest Edu Cert
Marks Result Transcript
Work Exp. Cert / Testimonial (1)
Work Exp. Cert / Testimonial (2)
Parent's marriage certificate
Bank Statement
Others

Email address is compulsory

Online transmission of relevant data for application of Student Pass or 
complete them and return hard copies to Steve Say  史 帝 富 - Filmo, 
1 Sophia Road #02-16 Peace Centre Singapore 228149