STAFF-IN-CONFIDENCE

PERSONAL PARTICULARS FORM

PART I PERSONAL PARTICULARS

Name as in NRIC/Passport
If married woman, state maiden name
(Mr/Miss/Mdm) / Chinese Characters
Aliases / Chinese Characters
NRIC No. / Citizenship / Citizenship Cert No.
-compulsory if SC(by Reg) / Date of Issue
- compulsory if SC(by Reg)
Date of Birth / Place of Birth / Race
Dialect / Religion/Specify denomination, if any
Place of Worship
Other Citizenship currently
Held
(since when) / Other Permanent Residence currently held
(since when) / Sex: *Male / Female / Marital Status
*Single/Married/Separated/
Widowed/Divorced
Present Address in Singapore (include Block and Postal District Nos.) / Telephone Nos.
Home:
Cellular:
Office:
Email Address:

FOR FOREIGNERS ONLY

Types of Travel Document Held & Number / Date of Issue / Place of Issue / Date of Expiry
Address in Country of Origin / FIN No.

*Delete where applicable

PART II COUNTRIES IN WHICH APPLICANT HAD RESIDED DURING THE PAST TEN YEARS

Period of Stay / Address / Country
From / To

PART III EDUCATIONAL QUALIFICATIONS IN CHRONOLOGICAL ORDER

Name of School/College/University Attended
(irrespective of whether they are foreign or local) / Country / Duration of Course / Academic Qualification Attained
Date Joined / Date Left
Primary
Secondary
Post Secondary
Tertiary
Post Tertiary
Others

PART IV MILITARY SERVICE (SINGAPORE CITIZENS ONLY)

Date of Enlistment / ORD/SCD / Rank / Unit / Vacation

PART V KNOWLEDGE OF LANGUAGES AND DIALECTS

Written and Spoken / Spoken Only

PART VI HOBBIES AND RECREATIONAL ACTIVITIES

PART VII PREVIOUS AND PRESENT EMPLOYMENT IN CHRONOLOGICAL ORDER

Period of Employment / Name and Address of Employer as well as Your Designation for Each Period of Employment
From / To
Name of Employer
Address of Employer
Designation
Name of Employer
Address of Employer
Designation
Name of Employer
Address of Employer
Designation
Name of Employer
Address of Employer
Designation
Name of Employer
Address of Employer
Designation
Name of Employer
Address of Employer
Designation
Name of Employer
Address of Employer
Designation
Name of Employer
Address of Employer
Designation

PART VIII PREVIOUS AND CURRENT SUPERVISORS

Previous Supervisors / Designation / Period / Office/Cellular No.
Current Supervisor / Designation / Since When / Office/Cellular No.

PART IX PARTICULARS OF PARENTS, BROTHERS, SISTERS, SPOUSE AND ALL CHILDREN

State whether you are the only child: Yes No
If no, please indicate the number of : Brothers Sisters
State whether you have any children: Yes No
If yes, please indicate the number of : Sons Daughters
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address

PART X PARTICULARS OF ANY RELATIVES KNOWN TO BE WORKING IN FOREIGN GOVERNMENT ESTABLISHMENTS: EMBASSIES/ HIGH COMMISSIONS/ INTELLIGENCE SERVICES/ ARMED FORCES/ CIVIL SERVICE

Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address
Names as in NRIC/Passport / Chinese Characters
NRIC/Passport No. / Sex / Marital Status / Occupation
Daye of Birth / Place of Birth / Relationship
Citizenship / Other Citizenship currently held
(since when) / Other Permanent Residence currently held
(since when)
Home Address
Employer / School Name
Employer’s Address

PART XI MEMBERSHIP OF SOCIETIES, CLUBS AND ASSOCIATIONS, AND PROFESSIONAL BODIES

Name and Address of Societies/ Clubs/ Associations/ Professional Bodies (in full) / Date Joined / Position Held

PART XII OWNERSHIP OF LOCAL AND OVERSEAS ASSETS (INCLUDING PROPERTIES/ OTHER INVESTMENTS)

Description of Properties/ Investments/ Assets / Country / Date Purchased / Estimated Value (S$)
Address (including district and lot nos. for properties

PART XIII PARTICULARS OF TWO REFEREES KNOWN TO APPLICANT FOR 2 YEARS OR MORE

(The Referees should be Singapore residents and Non-Relatives, and are prepared to be interviewed.)

Names in NRIC/ Passport
If married woman, state maiden name
*Mr/Miss/Mdm / NRIC No. / Sex / Chinese Characters
Name & Address of Employer
Tel No: / Occupation
Home Address (Include Block and Postal District No.) Cellular No:
Home Tel No:
In what capacity do you know *him/her
Names in NRIC/ Passport
If married woman, state maiden name
*Mr/Miss/Mdm / NRIC No. / Sex / Chinese Characters
Name & Address of Employer
Tel No: / Occupation
Home Address (Include Block and Postal District No.) Cellular No:
Home Tel No:
In what capacity do you know *him/her

PART XIV DECLARATION

I give my consent for the relevant Government authorities to obtain and verity information from or with any source, as you deem appropriate for assessment of my application for employment/suitability for a sensitive deployment and/or access to highly classified information. I also declare that the particulars stated above are true and correct to the best of my belief and knowledge, and that I have not wilfully suppressed any material fact.
Signature______Date______

GOM No 204-01

ANNEX E

DECLARATION BY REGISTRANT/SAF PERSONNEL

1. aI, ______holder of NRIC No______hereby declare that I am unable to furnish the personal particulars of the following person(s) as required:

S/NoNAMERELATIONSHIPREASON FOR INABILITY TO OBTAIN INFORMATION

  1. ______
  1. ______
  1. ______
  1. ______
  1. ______
  1. ______
  1. ______
  1. ______
  1. ______

2. aThe above information given by me is true and I understand that criminal proceedings will be instituted against me under the Enlistment Act (Chapter 93) if I have given any false or misleading information.

b.The above information given by me is true and I understand that disciplinary action will be instituted against me, if I have given any false or misleading information.

______

Date

1

STAFF-IN-CONFIDENCE