Form 16 - Psb Academy (Page 2 of 2) in pdf

Part B – DECLARATION BY APPLICANT

I hereby declare that all the particulars furnished by me in this application are true and correct.

I undertake not to study without a Student’s Pass.

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 undertake to comply with the provisions of the Immigration Act and any regulations made thereunder or any statutory modification or

re-enactment thereof for the time being in force in Singapore.

I undertake not to involve in any criminal offences in Singapore.

I undertake not to indulge in any activities which are inconsistent with the purpose for which the immigration passes have been issued

I further undertake not to be engaged in any form of employment or in any business, profession or occupation in Singapore whether paid or unpaid,

without a valid work pass issued under the Employment of Foreign Manpower Act (Cap. 91A).

I am aware that overstaying or working illegally in Singapore is a serious offence and on conviction, the penalties may include mandatory

Imprisonment and caning.

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 give my consent for your department to obtain and verify information from or with any source, as you deem appropriate for the assessment of my

application for immigration facilities.

………………………………

………………………………………...

Date

Signature of Applicant

PART C – DECLARATION BY LOCAL SPONSOR

(A local sponsor is required to complete either section I or Section II below)

SECTION I – For application sponsored by a school/institute only.

Name and Address of School

We hereby sponsor this application and certify that it is made for the purpose as stated by the applicant.

The statements made in this application are true and correct.

We shall be responsible for the cost of the applicant’s repatriation and maintenance pending such repatriation, if necessary.

Official Stamp of School

Name/NRIC & Designation/Capacity

……………………………………

……………………

Signature of Person acting

Date

on behalf of the School

SECTION II – For application sponsored by an individual only.

Full Name in BLOCK LETTERS (Underline Surname)

Singapore NRIC No. □ Pink

□ Blue

Relationship to Applicant

Tel No.

Sex*

Date of Birth

□ Male

□ Female

I hereby sponsor this application and certify that it is made for the purpose as stated by the applicant.

The statements made in this application are true and correct.

I shall be responsible for the cost of the applicant’s repatriation and maintenance pending such repatriation, if necessary.

………………………………

………………………………………...

Date

Signature of Sponsor

IMM 16

– 2 –

THIS FORM IS ISSUED FREE

Form 16 - Psb Academy Page 2

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