*062715367010823*
WORK PERMIT RENEWAL NOTICE & APPLICATION FORM (printed on Tuesday 01 October 2024 10:29 PM SGT)
Renew early to avoid losing your worker
Another employer can submit an application for this worker from 21 to 40 days before the current work permit expires without needing
your consent. Complete the renewal now to avoid losing your worker. You will not be able to renew his permit if a new application from
another employer is being processed or after it has been approved. To check the status of such applications, go to 'WPOL > Enquire >
Application for Transfer Worker'.
1. This Work Permit Renewal Notice & Application Form is an In-Principle Approval (IPA) for the renewal of your worker's Work Permit.
2. You must update your worker’s residential address and mobile number using the Online Foreign Worker Address Service. Once the
details are updated, please wait at least 1 hour before renewing the Work Permit (WP).
3. You will be prompted to download the Security Bond form once for your organisation's first WP issuance or renewal transaction. You no
longer need to submit the form for the subsequent transactions. Please prepare PDF copies of the Work Permit Renewal Notice &
Application Form and worker's passport (pages showing the personal particulars and any amendments made) for the renewal
transaction.
4. You need to buy a $5,000 security bond from a bank or insurance company. Ensure your insurer sends MOM the bond before you
renew the WP. Log in to WP Online > click Enquire > Security Bond Status to check. The bond must also take effect when you renew
the WP or can be post-dated up to 1 day after the current Work Permit expires.
5. Log in to Work Permit Online (WPOL) to renew the WP.
Name of Employer : SAM AUTOMATION TECH & FIRE SAFETY PTE. CPF Submission No. : 202006507R - PTE - 01
LTD.
Name of Foreign Worker : BIPUL SB Transmission Ref No. : G792592
Work Permit No. : 0 62715367 Date of Application : 01/08/2023
Occupation : CONSTRUCTION WORKER WP Expiry Date : 16/10/2024
FIN : G8249423K
Declaration by the Foreign Employee:
For the purpose of applying for a visit pass under the Immigration Act, I declare that:
a) I have not ever been refused entry into or deported from any country/region;
b) I have not been convicted in a court of law in any country/region;
c) I have not been prohibited from entering Singapore; and
d) I have not ever entered Singapore using a different Passport and Name.
(You are required to indicate the details separately if any or all of the above is / are not in accordance with the above declaration.)
I undertake not to misuse controlled drugs or to take part in any political or other activities during my stay in Singapore which would
make me an undesirable or prohibited immigrant under the Immigration Act.
I understand that if the Controller of Immigration is satisfied that I or any member of my family breaches this undertaking or becomes
an undesirable or prohibited immigrant, he will cancel my immigration pass and the passes of the members of my family, and we may
be required to leave Singapore within 24 hours of such cancellation.
I consent to the Ministry of Manpower displaying my work pass details when my work pass card is scanned using the Ministry of
Manpower's work pass mobile application.
I give my consent for the Ministry of Manpower to use my contact details to contact me during emergencies and to send me
messages related to my work pass and employment in Singapore. I also consent for the Ministry of Manpower to share my contact
details with other Government agencies and statutory authorities for the same purposes.
Declaration by the employer:
I declare that I am aware that the Controller of Work Passes uses its Central Provident Fund contribution information to determine the
number of local workers employed by the employer hence determining the number of foreign employees that it may employ. The
employer has ensured that its Central Provident Fund contribution record of payments as employer required under the Central
Provident Fund Act (Cap.36) only reflects every citizen or permanent resident of Singapore who is employed by the employer and at
the appropriate contribution rate prescribed by law. The employer has made any voluntary CPF contributions only through a separate
CPF Submission Number (CSN).
The employer consents to the Ministry of Manpower displaying work pass details when the foreign employee's work pass card is
scanned using the Ministry of Manpower's work pass mobile application.
I declare that if the foreign employee travels out of Singapore while under my employment, I will make an application to Ministry of
Manpower to allow this foreign employee to return to Singapore, subject to prevailing entry requirements at the point of entry into
Singapore.
Declaration by the foreign employee and employer:
I / We declare that all the information provided above is true. I / We are aware if I / we make any false statements or produce any
documents that are false, I / we shall be guilty of an offence. The foreign employee's Work Permit will be revoked and the employer can
be barred from future employment of foreign employees.
Please ensure that the blanks below are filled in, especially the Date of Declaration and the Signatures.
Date of Declaration Signature of Foreign Worker Name, Designation & Signature of
Business Employer
Employer / Employment Agency Tel No. Name of Employment Agency if Name & NRIC / Passport No. of
authorised to act on employer's behalf Representative if authorised to act on
employer's behalf
FIWPS540 0 62715367
Medical Report of the Foreign Worker indicated above (To be completed by the
examining doctor)
The foreign worker is required to undergo HIV test and Chest X-ray. The HIV (AIDS) test
must be done at laboratories approved by the Ministry of Health.
I certify that the person examined is the holder of the Work Permit indicated above and
the results of the medical tests are as follows:
Test Results of Examination
Positive / Reactive Negative / Non-Reactive
HIV(AIDS) Test
Chest X-Ray To Screen for TB
Name & Signature of Examining Doctor Date
Name, Address & Telephone No. of the Clinic:
FIWPS540 0 62715367
IMPORTANT NOTE TO THE COMPANY AND FOREIGN WORKER
1.You are required to purchase and maintain Medical Insurance for your foreign worker's inpatient care and day surgery. For medical
insurance policies taken up or renewed on or after 1 Jul 2023, the insurance coverage must be at least S$60,000 per year per foreign
worker. You may update the company's insurance details using the "Medical Insurance Function" via WP Online.
2.To renew the WP, your company must have a valid Building and Construction Authority (BCA) or Singapore List of Trade Subcontractors
(SLOTS) registration certificate.
3. The expiry of the worker's Construction Safety Orientation Course (CSOC) or Apply Workplace Safety and Health in Construction Sites
certificate must be at least 1 month from the WP renewal date.
4. Please note that the foreign worker is still bound by the Conditions Of Work Permit which the foreign worker undertook to adhere to on
the first issue of the WP.
062715367/010823 BIPUL
FIWPS540 0 62715367
