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Application for Special Employee Licence

PERSONAL RELEASE AUTHORISATION


To: All courts, departments, employers, educational institutions, banks, credit bureaus, auditors, financial and revenue authorities and other institutions, all government agencies without exception both overseas and local and to whomsoever else this authorisation may be presented.

From: ., (Full name) .. (NRIC/FIN/Country ID No)* of

..., (Full address) (Telephone number)

The applicant for a: (a) (b) (c) (d) Category A special employee licence* Category B special employee licence* Category C1 special employee licence* Category C2 special employee licence*

As a requirement of the above application, I agree to allow the Casino Regulatory Authority of Singapore (CRA) and its authorised officers and agents to conduct an investigation into my background. This authorisation is for the purpose of allowing the CRA to obtain relevant information necessary to make a determination on my suitability in respect of the above application.

I HEREBY AUTHORISE the CRA and its authorised officers and agents to have access to and to inspect and obtain copies of: (i) Any credit report, other report, legal or commercial information derived from those reports that has any bearing on my credit worthiness, credit history, credit standing or credit capacity; Any personal income statements, information relating to income, income tax assessments and real estate holdings; Any loan information, cheque account records, savings deposit records, safe deposit box records, passbook records and bank statement sheets in relation to any account held directly or indirectly by me; Any records relating to investigations of my operations or activities conducted by any police force, crime investigation agencies or any gaming or casino regulatory bodies; Any court records relating to any present or past civil or criminal court proceedings to which I am or have been a party; and Any other document, record or correspondence reasonably related to these probity investigations.

(ii) (iii)

(iv) (v) (vi)

Application for Special Employee Licence

You are HEREBY AUTHORISED to release to the CRA and its authorised officers and agents all the documents, reports, records and information requested by any of them.

This authorisation shall supersede and countermand any prior request or authorisation to the contrary. A photocopy of this authorisation will be considered as effective and as valid as the original.

Dated the . day of 20

Signature of Declarant

.... Signature of Witness

. Name of Witness (any adult over the age of 21 can be a witness)

*Please delete whichever is not applicable.