EXAMINATION APPLICATION FORM Kindly fax completed form to 6327 3088
FOR CFE Use ONLY.
Immediate Officer Name : ____________________________________________ Account No. _________________
Registered online : Date : ___________________
Immediate Officer Email : ________________________________________________________________________
Payment : Cash Cheque Amt : S$ __________
Agency Group : __________________________________________________ Box : ________________________
Bank _______________ Cheque No. _____________
Introducing Officer Name : ________________________________(LPR/ELP/SELP) Account No. ____________ Amount to be debit : __________________________
Introducing Officer Email : _____________________________________________ Hp No. __________________ Debit Listing Prepared on : ____________________
Please indicate your office location : GE CHANGI GE HOUSE (Beach Road)
SECTION A : ENGLISH MEDIUM EXAMINATIONS (Module 5/Module 9/Health Insurance). Pls fill up accordingly.
Examination Module : First Attempt ($107) or Re-enrolment ($85.60)
Preferred Date(s) Preferred Time Slot (s)
Choice 1
Choice 2
Choice 3
SECTION B : BASIC COMPETENCY & CHINESE MEDIUM EXAMINATIONS (CMFAS M5/M8/M9/HI). Pls tick accordingly
Basic Competency Examination 1st 2nd Chinese Medium Examination 1st 2nd
BCE (Eng) & (Maths) 2.00pm to 4.45pm $85.60 - HI Chinese 3.55pm to 5.10pm $67.40 $56.70
BCE (Eng) 2.00pm to 3.30pm - $48.15 M5 Chinese 9.00am to 11.00am $90.95 $85.60
BCE (Maths) 3.45pm to 4.45pm - $48.15 M8 Chinese 3.55pm to 5.10pm $90.95 $85.60
M9 Chinese 9.00am to 11.30am $90.95 $85.60
SECTION C : MODULE 8 & HEALTH INSURANCE EXAMINATION (On Request Basis ONLY ). Pls tick accordingly.
For MODULE 8 Exam : 1st Attempt : $107 2nd / Subsequent : $85.60 (Computer Screen)
Preferred Date of Exam : _____________________________________(Choice 1) ______________________________ (Choice 2)
For HEALTH INSURANCE Exam : 1st Attempt : $83.50 2nd / Subsequent : $56.70 (Computer Screen)
Preferred Date of Exam : _____________________________________(Choice 1) ______________________________ (Choice 2)
SECTION D : PERSONAL DETAILS
Nationality Singaporean
1. NRIC No. / Passport No.: - - Permanent Resident (PR)
(Proceeding alphabet, if any must be indicated.) Others : ____________________
(Use PR No. for Singapore PR) (Please specify)
2. Mr / Mrs / Mdm / Ms * Full Name : _________________________________________________________________________________________
(as per NRIC or Passport) (Underline Surname)
3. Gender : Male Female Date of Birth:_________________________________________________
4. Age: 24 yrs & below 25 – 30 yrs 31 – 40 yrs 41 yrs & above
5. Home Address : _________________________________________________________________________________ Postal Code ( )
(Please use the same permanent address for all SCI Exams)
6. Tel Nos. Home : ____________________ Handphone : ___________________ Office : __________________ Fax No: ________________
**Email Address: _________________________________________________@___________________________________________________
(For Applicant(s) without Email Address, Examination confirmation will be sent to Immediate Officer by default)
7. Please indicate highest educational level attained
GCE 'O' Level GCE ‘A’ Level Diploma Degree Other Qualification ______________________
SECTION E : IMMEDIATE OFFICER DETAILS (COMPULSORY). Please fill up fully, to avoid delays in processing.
Declaration by Immediate Officer
I, ___________________________________________________ (Immediate Officer’s Name), Account No. _____________________________ being
the Immediate Officer of ______________________________________________________ (Candidate’s name) hereby authorise Great Eastern Life to
debit S$ __________________________________from the above stated Commission Account being payment of examinations fees for the above stated.
__________________________________ _____________________
Name & Signature of immediate Officer Date
DECLARATION
I declare that the information given to me in this application is true and correct. I understand that misrepresentation or omission is sufficient grounds for
rejecting my application. No Cancellation, Withdrawal or Replacement with be allowed and no fees refund will be made after
Registration.
__________________
Signature of Applicant Date
NOTES:
1. No Examination Entry Slip will be sent to you. Please check the status of your examination application(s) 2 working days before
the examination date via SCI website at www.scicollege.org.sg under Registration Confirmation. For successful application(s),
you will be notified of the examination confirmation and details.
2. Please keep a copy of this application form for your own record.
Kindly check that the information you have provided in this application is correct and accurate before submitting. Incorrect or
inaccurate information may affect the examination processing and your examination sitting.
3. CFE conducts regular Tutorial and Clinic sessions to facilitate learning. Kindly refer to your Immediate Officer for details of
Training Schedule. You may also access www.cfe-campus.com.sg for mock exam questions and answers. Kindly approach
your Introducing Officer/ Immediate Officer for password application.
4. Examinations are conducted at the Singapore College of Insurance, 9 Temasek Boulevard, #14-01/02/03, Suntec Tower 2
Singapore 038989
5. For clarifications, pls contact our Counter Personnel – Ms Karen Lee @ 6248 2219 or email to excellence@lifeisgreat.com.sg.
Thank You.
GST Reg No : M2-0129273-5
