Please type or write clearly in capital letters.

Do
not leave any space blank. Use “NIL” or “N/A”
where applicable.

Programme:
Course Title:
Course Dates:

PART ONE: APPLICANT DETAILS (TO BE COMPLETED BY APPLICANT)

Applicant's Particulars
Title Dr/Mr/Mrs/Ms/Others (please circle accordingly)

Family Name

Given Name

Date of
Gender
Birth
(dd/mm/yy)
Representin
Nationality
g
Government
of
Passport
Passport Number
Expiry Date
(dd/mm/yy)
Dietary
Religion
Restrictions (if
any)

Contact Details

Country/ State/ City/Town

Territory Province

Office Address
Postal Code
Countr Area Country Area
Code Numbe Code Code Numbe
y
Code r r

Telephone No. Mobile

Personal Email Other Email

Person to be notified in case of emergency

NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the
National Focal Point for Technical Assistance in your country/territory. Forms which are incomplete or not endorsed
will not be accepted.
Name Relationship
Country Code Area Code Numbe
r
Telephone
Address No.

Email

NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the
National Focal Point for Technical Assistance in your country/territory. Forms which are incomplete or not endorsed
will not be accepted.
Employment History
From To
Organisation Department Designation Nature of Job
(dd/mm/y (dd/mm/y
y) y)

PRESENT

Educational Qualifications
From To
Educational Qualification Attained Educational Institution
(dd/mm/y (dd/mm/y
y) y)

Professional Qualifications

Description of Date Attained

Qualification

Previous Attendance
Have you attended any courses sponsored under the Singapore Cooperation
Programme previously? If yes, please state the name and date of course(s). Yes/No

NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the
National Focal Point for Technical Assistance in your country/territory. Forms which are incomplete or not
PART TWO: DECLARATION (TO BE COMPLETED BY APPLICANT)
I, of
Name of applicant Representing Country/Territory

Declare that:

(a) All information provided is true, complete and accurate to the best of my belief and
knowledge, and that I have not wilfully suppressed any material facts;

(b) I am medically fit and free from any medical problems which may impair my ability
to attend and complete the training in Singapore;

(c) I am proficient in spoken and written English. (The course will be conducted in English. All
participants are expected to have a good working knowledge of the English language.);
and

(d) I will be personally liable for all medical expenses incurred during my stay in Singapore,
other than those covered under the Group Personal Accident Insurance and Group
Hospital & Surgical Insurance policy.

(IMPORTANT NOTE: All successful participants are covered under Group Personal
Accident and Group Hospital & Surgical Insurance, which does not cover any pre-
existing conditions/illnesses or any outpatient medical/dental treatment. Participants
are personally liable for all medical expenses beyond what is covered by the insurance
policy. As the coverage is limited, participants are advised to make their own
arrangements to obtain adequate medical insurance coverage for their stay in
Singapore.)

(e) (For pregnant applicants) I am months pregnant and am/am not certified by a
qualified doctor to be medically fit and in good health to travel and attend the training
in Singapore;

I fully understand that if I fail to comply with the terms and conditions of the training award,
and/or any of the above declarations are found to be untrue, the award will be terminated with
immediate effect and I will be liable to depart from Singapore at my own expense.

Date Signature of applicant

NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the
National Focal Point for Technical Assistance in your country/territory. Forms which are incomplete or not
 PART THREE: TO BE COMPLETED BY DIRECT SUPERVISOR
Please describe why the applicant has been nominated for this course:

Please describe what skills / knowledge you would like the applicant to gain from this course:

PART FOUR: ENDORSEMENT (TO BE COMPLETED BY NATIONAL

FOCAL POINT FOR TECHNICAL ASSISTANCE / MINISTRY OF FOREIGN
AFFAIRS OF NOMINATING GOVERNMENT)
By signing below, I confirm that I endorse the above nominee and that I believe all the
statements in this form to be correct.

(Ministry’s Official Stamp)

Name

Name of Organisation

Designatio
n - -
Country code Area code
Office tel no.

- -
Signatur Country code Area code
e Office fax no.

Email Address

NOTE: This application form should be duly completed and endorsed by the Ministry of Foreign Affairs or the
National Focal Point for Technical Assistance in your country/territory. Forms which are incomplete or not