moe bursary application form - Singapore University of Technology ...

MOE BURSARY APPLICATION FORM(FOR SINGAPOREAN FULL-TIME UNDERGRADUATES)INSTRUCTIONS TO APPLICANT1. This bursary application is open to Singaporean full-time undergraduates who are in financial need.2. A bursary may be awarded to the applicant depending on the applicant’s financial situation and criteria set down by MOE.If applicant withdraws or is terminated from studies, the bursary must be refunded.3. You cannot concurrently hold any other bursary/scholarship without approval of the University.4. Submit your completed application form together with the following documents to:Office of Student and Classroom AdministrationSingapore University of Technology and Design (SUTD)20, Dover Drive, Singapore 1386825. If you have queries, please email to studentadmin@sutd.edu.sg.DOCUMENTS TO BE SUBMITTEDA. Identification DocumentsFor students whose marital status is singlei. Parents (regardless if staying with you or not)ii. Siblings and other relatives staying in the same household as you.iii. Guardians (if your parents are not your guardian)For students whose marital status is marriedi. Spouseii. ChildrenCopy of NRIC / Birth Certificate / PassportB. Income DocumentsFor students whose marital status is SINGLEi. Parents who are employedLatest copy of Payslip/Income Tax Notice Of Assessment/Letter from employer indicating incomeii.Parents who are self employedLatest copy of Income Tax Notice Of Assessment/ Self-Declaration Letter*iii.Parents who are unemployed or retrenched (includinghousewife)Self-Declaration Letter*/Retrenchment Letter*Self-Declaration Letter must be dated and include full name, IC/ Passport no., occupation, income amount and his/her signature.For students whose marital status is MARRIEDi. Spouse who is employedLatest copy of Payslip/Income Tax Notice Of Assessment/Letter from employer indicating incomeii.Spouse who is self employedLatest copy of Income Tax Notice Of Assessment/ Self-Declaration Letter*iii.Spouse who is unemployed or retrenched (includinghousewife and retiree)Self-Declaration Letter*/Retrenchment Letter*Self-Declaration Letter must be dated and include full name, IC/ Passport no., occupation, income amount and his/her signature.C. Other Documentsi. Parents who are divorced Copy of Divorce Documentii. Parents who are deceased Copy of Death Certificateiii. Other Supporting documents Copy of Medical Report/ Welfare assistance

MOE BURSARY APPLICATION FORM(FOR SINGAPOREAN UNDERGRADUATES-FULL-TIME COURSE)The application form should be typewritten or legibly written in BLOCK LETTERS. (Indicate “NA” if any field is not applicable)Term: Student ID: Ref no.: (for office use only)Please state when the BURSARYis to take effect from:Academic Year:A. Particulars of ApplicantFull Name as in NRIC/Passport: Mr / Mdm / Miss (please underline surname) Marital Status: Date of Birth:NRIC/Passport No.: Country of Issue: Citizenship:Postal Address in Singapore: Mailing Address in Singapore: Home Tel. No.: (in Singapore)Permanent Home Address: (in Singapore)Mobile No.: (in Singapore)Email Address:Overseas Tel No.:B. Family Background and Financial Status (FBFS)For applicants who are SINGLE, please complete Section B1, C, D, E and F.For applicants who are MARRIED, please complete Section B2, C, D, E and F.#Employment status: Student, NS men (full-time), Employed, Self-employed, Unemployed, Retrenched, Housewife, Retired or Deceased.+Refers to income or bonus before deduction of CPF etc. Please indicate “0” if no income or contribution.B1. For students whose marital status is SINGLE (All fields are to be completed. Indicate “NA” or “0” if not applicable.)B1a. Details of ParentsFather’s Name:Age:Marital Status:Employment Status # :Living in the same household: Yes / No*Occupation:Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthMother’s Name:Age:Marital Status:Employment Status # :Living in the same household: Yes / No*Occupation:Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)B1b. Details of SiblingsSibling’s Name:S$ per monthAge:Marital Status:Living in the same household: Yes / No* Relationship: Brother SisterEmployment Status # : Occupation: Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthSibling’s Name:Age:Marital Status:Living in the same household: Yes / No* Relationship: Brother SisterEmployment Status # : Occupation: Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthOSCA-MBS Page 1 of 4

Sibling’s Name:Age:Marital Status:Living in the same household: Yes / No* Relationship: Brother SisterEmployment Status # : Occupation: Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthSibling’s Name:Age:Marital Status:Living in the same household: Yes / No* Relationship: Brother SisterEmployment Status # : Occupation: Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthSibling’s Name:Age:Marital Status:Living in the same household: Yes / No* Relationship: Brother SisterEmployment Status # : Occupation: Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)B1c. Details of Grandparents staying with your family (if any)Grandfather’s Name:S$ per monthAge:Marital Status:Employment Status # :Living in the same household: YesOccupation:Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthGrandmother’s Name:Age:Marital Status:Employment Status # :Living in the same household: YesOccupation:Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)B1d. Details of Guardian (if any)Guardian’s Name:S$ per monthAge:Marital Status:Employment Status # :Living in the same household: Yes / No*Occupation:Remarks:Gross Monthly Income/Pension + : S$ per monthGross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthOSCA-MBS Page 2 of 3

B2. For students whose marital status is MARRIED (All fields are to be completed. Indicate “NA” or “0” if not applicable.)B2a. Details of SpouseSpouse’s Name:Age:Living in the same household: Yes / NoMarital Status: Employment Status # : Occupation:Gross Monthly Income/Pension + : S$ per monthRemarks:Gross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthB2b. Details of Children (if any)Child’s Name:Age:Living in the same household: Yes / NoMarital Status: Employment Status # : Occupation:Gross Monthly Income/Pension + : S$ per monthRemarks:Gross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthChild’s Name:Age:Living in the same household: Yes / NoMarital Status: Employment Status # : Occupation:Gross Monthly Income/Pension + : S$ per monthRemarks:Gross Annual Bonus + : S$ per annumMonthly Contribution to Family:(only to be filled up if divorce or separated)S$ per monthC. OTHER SOURCES OF INCOMEOther Sources of Family Income Per Year : Savings Interest / Rental Income / Financial help from organization / Others*Remarks (if any): S$ per yearCash Savings of parents (if single) / of spouse (if married): S$Your own Cash Savings S$D. If your family has no income at all , please explain in the box below on how your family covers its expensesE. ADDITIONAL INFORMATION1. Are you in receipt of:a) Tuition Fee Loan Yes / No*b) CPF Education Scheme Yes / No*c) Mendaki Tertiary Tuition Fee Subsidy Yes / No*2. Other than the loans indicated above, are you receiving or have applied for Scholarships, Bursaries, Loans or other forms of Financial Assistance for your study at SUTD?If yes, please furnish details below:Academic Year Name of Award/Loan Value of Award/Loan Outcome of Application3. Is there any family member who is suffering from an illness and staying in the same household? Yes / NoIf yes, please state who and provide details:S$S$4. Describe in detail any other information to support your applicationF. DECLARATIONI declare that the information and attachments provided in this application are true and accurate to the best of my knowledge and that I have not willfully suppressed anymaterial fact. I understand that the provision of any inaccurate or false information will render this application invalid.Signature of Applicant:Date:* please delete accordinglyOSCA-MBS Page 3 of 3