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National University of Singapore
Financial Aid & Scholarships Application Form (Summary)
Your online application was received on 02-Feb-2015 12:38:03 AM

Name:
Student No. / Application No.:
Course & Year of Study:
Academic Year and Semester:
Nationality:
Contact No. & Email:
Scheme applied for:

MR LIM ZIJIE JOSHUA
A0124015Y
ARTS AND SOCIAL SCIENCES, YEAR 1
2015/2016, 1
SINGAPORE
96899189(HP), A0124015@U.NUS.EDU

Financial Aid & Scholarship

1. Please save and PRINT this form and submit it with the relevant supporting document(s) to the
Office of Financial Aid within two weeks from the online submission date as stated above to avoid
any delay in the processing of your application.
2. If you wish to make changes to any information in this form, please make the changes in the printed
form and sign beside the changes.
Supporting Documents Checklist
(a) All Financial Aid applicants are to submit a photocopied version of the following documents, where applicable.
Only original copies of Declaration Form A1, A2, B and F are acceptable. You can login to the Undergraduate
Financial Aid Portal again to print these Declaration Forms.
Document:
1. Identification documents stating nationality and existing home
address. If any of the information is not indicated, certified
documents by the local authorities stating both the
information are required.
2. Latest salary slip or recent letter from employer stating
current gross monthly salary or latest income tax assessment
stating income for the year or Declaration Form A1
(in the above order of priority)
3a. Latest income tax assessment stating income for the
year; and
3b. Declaration Form A1
4. Retrenchment letter
5a. **CPF / EPF latest 12-month statement; and
5b. Declaration Form A2

Compulsory in respect of :
Applicant, all household members staying with applicants
and immediate family members who are not staying with
applicant
Salaried family member(s)

Self-employed family member(s)

Retrenched family member(s)
Housewife/Retired/unemployed family member(s)
(not applicable to students who are 21 years old and below)

** Applicable only to those who are aged 62 and below.

6. Student Card / Admission offer letter
7a. Document stating medical condition(s) from a certified
general practitioner / doctor (if available); and
7b. Latest 3-months medical bills (if available); and
7c. Declaration Form F
8. Death certificate
9. Divorce or separation deed and alimony documents

Schooling family members who are 22 years old and above
Applicant/family member(s) suffering from any of the
following:
- Medical condition(s)
- Physical or mental disability
Deceased immediate family member(s)
Applicant’s parents who are divorced or separated

(b) In addition to the above, applicants who reported no (zero) family income will need to submit Declaration Form B
(Expense Worksheet) together with a photocopied version of the following documents, where applicable:
Document:
1. Latest utilities and phone bills
2. Vehicle loan agreement or payment advice (if applicable)
3. Latest credit card bill (if applicable)
(c) Applicants for Donated Scholarships are only required to submit the Application Form (Summary) and supporting
documents upon request by the Office of Financial Aid.
(d) All applicants have to sign on the last page of this form. For those who are under 18 years old at the point of
application, you and your parent/guardian are required to sign on the last page of this form.

3. Please submit your documents by hand/post to the Office of Financial Aid at:
Office of Financial Aid (within Office of Admissions), National University of Singapore, University Town,
2 College Avenue West, #01-03 (Stephen Riady Centre), Singapore 138607
Tel: (65) 6516-2870 Email: financialaid@nus.edu.sg
Operational Hours:
Monday - Thursday: 8.30 am - 6.00 pm; Friday: 8.30 am – 5.30 pm; Weekends & Public Holidays: Closed
AO/Forms-01/2015

/School Monthly Gross Income: Currency: Last Drawn Salary date: Name: Age: Relationship: Highest Educational Level: Marital Status: Employment Status: Job Title Job Sector Name of Co./School Popular Book Company (Pte) Ltd.NUS: Application for financial assistance. Joseph'S Institution Monthly Gross Income: 0 Currency: Family Member 2 Singapore Dollar Last Drawn Salary date: Family Member 3 Name: Age: Relationship: Highest Educational Level: Marital Status: Employment Status: Job Title Job Sector Name of Co./School St./School Monthly Gross Income: Currency: Last Drawn Salary date: Name: Age: Relationship: Highest Educational Level: Marital Status: Employment Status: Job Title Job Sector Name of Co. (Include siblings who are studying abroad) Family Member 1 Name: TAN SIEW LAY Age: 50 Relationship: Mother Highest Educational Level: GCE 'O' Level Certificate Marital Status: Separated Employment Status: Employed Job Title Store Assistant Job Sector Retail Services Name of Co.htm (1 of 3)2/26/2007 9:17:06 AM . Monthly Gross Income: 1200 Currency: Singapore Dollar Last Drawn Salary date: Name: JAYDEN LIM Age: 11 Relationship: Brother Highest Educational Level: Marital Primary/Junior School Certificate Status: Single Employment Status: Student Job Title Student Job Sector Name of Co.Family Members Student Number: A0124015Y 2.1 Family members staying with applicant in home country./School Monthly Gross Income: Currency: Last Drawn Salary date: Name: Age: Relationship: Highest Educational Level: Marital Status: Employment Status: Family Member 4 Family Member 5 Family Member 6 file:///D|/Projects/webroapsbs/Misc/Htmls for pdf/index. FINANCIAL INFORMATION 2.

please provide relevant medical reports) Yes No c) Are any of your family members suffering from any physical or mental disability? (If Yes.NUS: Application for financial assistance./School Monthly Contribution: Currency: Last Drawn Salary date: Name: Age: Relationship: Highest Educational Level: Marital Status: Employment Status: Job Title Job Sector Name of Co./School Monthly Contribution: Currency: Last Drawn Salary date: Family Member 3 Family Member 4 Total: 1400 2./School Monthly Contribution: Currency: Last Drawn Salary date: Name: Age: Relationship: Highest Educational Level: Marital Status: Employment Status: Job Title Job Sector Name of Co.Family Members Job Title Job Sector Name of Co.2 Family members not staying with applicant in home country (include siblings who are married) Family Member 1 Name: LIN QIULING.htm (2 of 3)2/26/2007 9:17:06 AM Yes No . JESSICA Age: 32 Relationship: Sister Highest Educational Level: Diploma Marital Status: Married Employment Status: Employed Job Title Hr Admin Job Sector Others Name of Co. please provide relevant medical reports) b) Are you suffering from any medical condition? (If Yes./School Monthly Gross Income: Currency: Last Drawn Salary date: Name: Age: Relationship: Highest Educational Level: Marital Status: Employment Status: Job Title Job Sector Name of Co. please provide relevant medical reports) Yes No d) Are any of your family members suffering from any medical condition? (If Yes.3 a) Are you suffering from any physical or mental disability? (If Yes. please provide relevant medical reports) file:///D|/Projects/webroapsbs/Misc/Htmls for pdf/index./School Monthly Gross Income: Currency: Last Drawn Salary date: Family Member 7 2./School Singapore Post Monthly Contribution: 200 Currency: Singapore Dollar Last Drawn Salary date: Family Member 2 Name: Age: Relationship: Highest Educational Level: Marital Status: Employment Status: Job Title Job Sector Name of Co.

[100 to 200 words]. I declare and warrant that for any personal data of other individuals disclosed by me in connection with this application. incomplete or false information given or any omission of information required shall render this application invalid and NUS may at its discretion withdraw any offer of acceptance made to me on the basis of such information or. My mother is the sole breadwinner in the family and has to support both my brother and I. Third parties include (i) the Ministry of Education. if already admitted. My brother is only 12 years old and hence has no income. prior to disclosing such personal data to NUS. DECLARATION ✔ ✔ ✔ ✔ I hereby declare that all information provided by me in connection with this application is true. including myself. I have read and agree to the terms and conditions contained in the Personal Data Notice and Consent. Once an application is submitted. 2. My family consist of three people. obtained the appropriate consent from the individuals whose personal data are being disclosed. I may be liable to disciplinary action. as set out fully in the Personal Data Notice & Consent. other government agencies or statutory bodies or non-government agencies authorised to carry out specific Government services or duties and (ii) persons or organisations providing students with scholarships and/or financial aid. Yes No I agree to receive marketing. accurate and complete. which may result in my expulsion from NUS. electronic mail. Date: 02-Feb-2015 12:38:03 AM Note: Only sections 2 and 6 of the application form will appear in the ASD. Yes No I agree to receive marketing. And I hereby authorise NUS to obtain and verify any part of the information given by me from or with any source (such as Ministry of Education).2. I have. as set out fully in the Personal Data Notice & Consent. 6. advertising and promotional information from NUS at my telephone number provided above via FDOO/ phone call. to permit NUS to collect. SMS or MMS and/or fax. use and disclose such personal data for purposes related to this application. as it deems appropriate. advertising and promotional information from NUS via postal mail.4. Summary of current family financial situation which explains your need for financial aid. I understand that any inaccurate. Signature of applicant(Parent/Guardian has to sign if student is under 18 year old) Date . My sister has her own family and commitments and thus can only contribute a limited amount to the family. I agree that all such information provided by me in connection with this application may be disclosed to authorised NUS personnel or third parties on a need-to-know basis for purposes related to this application.5 Explanation on how your family supports itself (applicable only to those with ‘$0’ income). you will not be able to amend the submitted information in the application system.