Full Name as Passport strictly Date of Birth Sex Country of Birth as Passport State of Birth (no village / city

/ district) Race Religion / Denomination Marital status Nationality Passport Number Passport Issuing Country Passport issuing state (no village / city / district) Passport issuing date Passport expiry date PRC ID: (CHINA Citizen Only) Country of Origin State of Origin (no village / city / district) Prefecture/ Province of Origin Address in Country of Origin Nationality of Spouse Occupation Highest Qualification Attained Purpose of Visit

e.g. Surname then Given name e. g. 26011956 (no space and lines)

e. g. Punjab

e. g. Punjab e. g. 21032011 (no space and lines) e. g. 20032015 (no space and lines)

e. g. Punjab

e.g. University/ Diploma/ Secondary/ Primary/ NA e.g. Tourism/ Visiting Relatives.

Date of Intended Arrival in Singapore How long you intend to stay in Singapore e. g. Up to 30 days

If your intended stay in Singapore is more than 30 days, please state the reason for your intended length of stay and the duration. Where will you be staying in Singapore Singapore Address Did you reside in other countries, other than your country of origin, for one year or more during the last 5 years If YES, please provide details: Period of Stay? Country? Address? From? To? Have you ever been refused entry into or deported from any country, including Singapore? Have you ever been convicted in a court of law in any country, including Singapore? Have you ever been prohibited from entering Singapore? Have you ever entered Singapore using a different passport or name? If any of the answer is YES, please provide details below VISA delivery address (Only for Level-2 countries applicant) e.g. Regular Processing Express Processing Level-2 Countries Including country code e.g. Hotel/ Relatives place/ Friends place

Service Require as

Phone number