Application For Withdrawal

from Entire Examination

Singapore-Cambridge GCE N(T)/N(A)/O/A-Level Examinations
(Applicable for 2021 Private Candidates only)

NOTES ON THE COMPLETION OF THIS FORM

1. This application form may take you approximately five minutes to complete and will require the candidate's personal
particulars.
2. All fields are mandatory and must be completed in English in clear BLOCK LETTERS.
3. The application for withdrawal must reach SEAB before the start of the year-end written examination.
4. You may be given a 50% refund of subject fee paid (inclusive GST) if you submit your withdrawal request to SEAB by 30
Jun 2021. There will be no refund for a request made after the deadline.
5. If you are entitled to a refund, the amount will be refunded to you approximately 30 days after approval has been made by
SEAB, via:
a) A cheque will be sent to the address that you have provided during registration (if you have paid your examination fees through
Sing Post/ SAM/ NETS/ Cash/ Internet Banking) OR
b) the credit / debit card that you have used to pay for your examination fees
6. You must email the completed, signed and dated application form as well as the supporting documents (if applicable) to
SEAB_GCE_Admin@seab.gov.sg.

Section 1 - CANDIDATE’S PERSONAL PARTICULARS

NRIC/ FIN / Passport Examination Level (TICK () relevant box)

 N(T)- & N(A)-Level  O-Level  A-Level

Full name in NRIC/ FIN/ Passport (UNDERLINE surname)

Telephone Number Mobile Number

6
Block/ House Number Street Name

Unit Number Postal Code Email Address

#

Section 2 – REASON FOR WITHDRAWAL

Tick () reason(s) for withdrawal
 Admission to Tertiary Institutions
 Medical Reason(s)
Supporting documents to be submitted with application form
- Letter(s) of acceptance issued by the tertiary institutions for admission to a full-time
course
- Medical documents (e.g. Letter from doctor to certify that the candidate is unfit
throughout the examination period)

- NS Enlistment Letter AND

 National Services (please specify NS
Enlistment date):
_________________________________
 Others (please specify reason):
___________________________________
- Certification letter from army unit to certify that the candidate is still serving NS during
the year-end examination period. This period must coincide with the examination
period that the candidate has registered for the examination(s).
- Supporting documents (if applicable)

Application for Withdrawal Form

 Section 3 – ALTERNATE PAYEE
(Only applicable to application that is entitled to refund and that has the registration payment
made via Sing Post/ SAM/ NETS/ Cash/ Internet Banking)

I, ________________________________ (Full Name), ____________________ (NRIC/ FIN/ Passport), authorise the refund of the
examination fees to ________________________________ (Full Name), ____________________ (NRIC/ FIN/ Passport). The recipient
of the refund has a local bank account in Singapore.

Alternate Payee’s address (if different from Section 1 – CANDIDATE’S PERSONAL PARTICULARS):
____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Section 4 – DECLARATION

I confirm that I would like to withdraw from the examination and that all information in this form is correct. I acknowledge that there will be
no results or results slip/ examination certificates issued, for any subjects or components of subjects that the candidate may have
taken. If the results for any examination e.g. Mid-Year Mother Tongue Language examination results) have been released, these
results will be invalidated.

Signature : ________________________________________ Date (DD/MMM/YYYY) : _______________________________

Application for Withdrawal Form