III. SUPPORTING DOCUMENTS (It is mandatory to submit all documents stated below. Documents submitted will be kept by ESU and will not be returned) 1)

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1 INSTRUCTIONS ESU Learning Award is intend to recognise the efforts of our lower-income union member in balancing work and studies to attain tertiary-level qualification. I. ELIGIBILITY CRITERIA 1) The award is open to all ESU Ordinary Branch (OB) members and Directly-Serviced General Branch (DSGB) members who had pursued a diploma, degree, masters or PhD course in the following institutions/ universities: local polytechnics, LASALLE, NAFA, MDIS, Informatics, NTUC LearningHub, MMI Academy, SIM, SEED Institute, Advent- Links SAUC, NTU, NUS, SMU, UniSIM, SIT, SUTD 2) Members who are currently applying, receiving or have received scholarship/ bursary award from other organisations for year 2016 are not eligible to apply for the above award. 3) Member must be a paid-up member with at least 3 months of continuous membership at the point of application. II. SELECTION CRITERIA 1) Member MUST minimally pass all subjects 2) Income Criteria: i. Total Monthly Gross Household Income + of $3,000 and below; OR ii. Per Capita Income of $850 and below if gross household income exceeds $3,000 + Gross income is defined as all income derived from employment/ business. Inclusive of overtime and allowances. 3) Attendance for successful applicants at the award presentation ceremony is compulsory. Applicants are not allowed to nominate proxies to collect the award on their behalf. The award presentation will be held on Saturday, 25 th March 2017, morning. 4) Member will be informed of the success of their application(s) and the confirmed details of the award presentation via post. 5) Successful applicants who absent themselves from the award presentation would have forfeited their awards. 6) Successful applicants will receive a cash award of S$200. ESU Learning Award 2016 Instructions Page 1/2

2 III. SUPPORTING DOCUMENTS (It is mandatory to submit all documents stated below. Documents submitted will be kept by ESU and will not be returned) 1) Completed Application Form One application form per member. 2) Photocopy of most recent academic result slips for final semester examinations for AY 2015/2016. For course with modular result slips, please attach all modular results slips 3) Photocopy of member s NRIC 4) Photocopy of Birth certificate(s) or Identification card(s) of family members living in the same household 5) All working member/ family member must attach latest pay-slip and not CPF Contribution Statement. 6) Only non-working member /family member is to submit CPF Contribution statement. 7) Any other relevant supporting documents. IV. ENQUIRIES & SUBMISSION 1) Every item in the application form must be filled up. Where not applicable, please state NA. 2) Application forms must be duly completed and submitted with the relevant supporting documents (stated in Part III above). Forms must reach ESU HQ by 12.00pm, Friday, 16 th December ) The decision of the Selection Committee is final. Successful applicants will be notified by post and must be personally present at the award presentation to receive the award. 4) ESU reserves the right to reject incomplete or late submissions. 5) Please submit completed applications to the below. A text message will be sent by 23 rd December to confirm our receipt of your application. Please contact us at T: if you do not receive our confirmation text message by 23 rd December. Mailing Address: Education Services Union 605B, Macpherson Road #07-08, Citimac Industrial Complex Singapore OR Fax: For enquiries, please contact Ms Ash Chng at Tel: ext 10 or ash_chng@ntuc.org.sg. ESU Learning Award 2016 Instructions Page 2/2

Email Address 电子邮件地址 : Home 家 : 身份证号码 : Office 办公室 : Mobile 手机 : Nationality 国籍 : Date of Birth Gender 性别 : Marital Status 婚姻状况 : 出生日期 : Single 未婚 Married 已婚 Divorced 离婚 Others 其他 Name of Company 公司

3 REFERENCE NO Please Complete All Fields 请完成所有字段 APPLICATION FORM ESU LEARNING AWARD 2016 (FOR MEMBER ONLY) I. Member's Personal Particulars 会员个人资料 Full Name 全名 (as stated in NRIC): Residential Address 地址 : Postal Code 邮编 : Tel No 电话号码 NRIC No. Address 电子邮件地址 : Home 家 : 身份证号码 : Office 办公室 : Mobile 手机 : Nationality 国籍 : Date of Birth Gender 性别 : Marital Status 婚姻状况 : 出生日期 : Single 未婚 Married 已婚 Divorced 离婚 Others 其他 Name of Company 公司 : Occupation 职业 : Member s Monthly Gross Salary 月薪 : No of Persons living in the same household (including member) 家 Total Monthly Gross Household Income* (including member) 家庭总收入 Per Capita Income [Formula: (2) (1)] 每人平均收入 ( 方程式 : (2) (1) : 庭人数 ( 包括本人 ) ---- (1) : ( 包括本人 )---- (2) : II. Member's Course Information 会员课程资料 Name of Institution 学府 : Course of Study & Duration 课程名称与课程长度 : Faculty/Department 学院 / 学系 : Year of Study 学年 : ESU Learning Award 2016 Application Form Page 1/5

4 Member's Particulars 会员个人资料 Name 姓名 : NRIC No 身份证号码 : III. Examination Results 成绩 (Please attach additional copies of the table below if insufficient) Examination & Year 考试与年份 Examination & Year 考试与年份 Subjects 科目 Grade 成绩 Subjects 科目 Grade 成绩 ESU Learning Award 2016 Application Form Page 2/5

5 Member's Particulars 会员个人资料 Name 姓名 : NRIC No 身份证号码 : IV. Particulars of Family Members Living in the Same Household ( 家庭成员资料 ) Relationship to Gross Monthly Employer 公司 / Name NRIC No. Occupation Applicant Income (S$) School 姓名身份证号码职业与申请人的关系每月收入 Attending 学校 *Please refer to Part III of Instructions sheet for supporting documents required ESU Learning Award 2016 Application Form Page 3/5

6 Member's Particulars 会员个人资料 Name 姓名 : NRIC No 身份证号码 : V. Others State who are the other family members within the same household applying for the ESU U Care Bursary & Scholarship Awards 2016:- 请列出其他家庭成员申请 ESU 奖学金及助学金 2016:- Name of family member Relationship to Applicant NRIC No Education Level 名字与申请人的关系身份证号码学历 Other Supporting Reasons for Application 其他相关原因 (Please tick in the appropriate box below) I am a single parent. 我是名单亲家长 Other reasons, please specify 其他原因 : Please submit photocopy of relevant supporting documents if any. 如有相关文件, 请提交文件副本 VI. Declaration 1. I hereby declare that the particulars stated in this application are true and I have not willfully suppressed any material fact. 我在此声明, 本申请表所载的资料是真实, 我没有故意隐瞒任何重要事实 2. I also declare that I did not receive bursary/study grants from other organisations/institutions at the time of application. 我也声明我没有收到其他组织 / 机构的资助或助学金 Signature of Member 会员签名 Date 日期 VII. Declaration by applicant (form that is not signed will not be processed) 1. I hereby declare that I have understood and complied with the eligibility criteria stated in this application form. 我在此声明我已理解并符合申请表格上列明的资格标准 2. By providing my personal particulars in this application form, I have given consent for ESU to contact me regarding the outcome of my application via voice call, SMS, or mail. 通过提供我的个人资料, 我已经同意让职总通过电话, 短信或邮件来联系我有关于我的申请结果 3. I understand and consent that any information declared will be updated by ESU. 我已理解以及同意在表格中所填写的资料将会更新在我的职总记录 4. I accept the decision of ESU is final and no further correspondence will be entertained. 本人接受一旦审核完毕, 任何相关询问将不受理 Name of Applicant Signature & NRIC of Member Date 申请者姓名会员签名 & 身份证号码日期 ESU Learning Award 2016 Application Form Page 4/5

7 VIII. For Official Use Date received...: Remarks :... REMINDER: Please ensure that your application consists of the following documents: 1. Completed application form - One application form per member. 2. Photocopy of most recent academic result slips for final semester examinations for AY 2015/2016. For courses with modular result slips, please attach all modular results slips. 3. Photocopy of member s NRIC. 4. Photocopy of Birth certificate(s) or Identification card(s) of family members living in the same household. 5. All working member/ family member must attach latest pay-slip, not CPF Contribution Statement. 6. Only non-working member /family member is to submit CPF Contribution statement. 7. Any other relevant supporting document(s). ESU reserves the right to reject incomplete and late submissions. All complete applications must reach ESU Office by 12pm, Friday, 16 th December 请确保您的应用程序包括下列文件 : 1 填妥的申请表 - 申请表, 每名成员 2 最近期的学术 AY2015/2016 年的最后一个学期考试成绩单复印件对于课程模块化成绩单, 请附上所有模块化结果单 3 成员的身份证复印件 4 生活在同一个家庭的家庭成员的出生证明或身份证复印件 5 所有工作成员 / 家庭成员强制安装最新的工资单, 而不是公积金贡献表 6 只有非工作成员 / 家庭成员提交 CPF 贡献语句 7 任何其他相关的配套文件 (S) ESU 有权拒绝不完整和迟交文件所有完整的申请表须在 12pm, Friday, 16 th December 2016, 递交到 ESU 总部 Education Services Union (ESU) Contact details: Mailing Address: Education Services Union 605B, Macpherson Road #07-08, Citimac Industrial Complex Singapore ash_chng@ntuc.org.sg Tel: ext 10 Fax: ESU Learning Award 2016 Application Form Page 5/5

Microsoft Word - (web)_F.1_Notes_&_Application_Form(Chi)(non-SPCCPS)_16-17.doc

Microsoft Word - (web)_F.1_Notes_&_Application_Form(Chi)(non-SPCCPS)_16-17.doc 聖保羅男女中學學年中一入學申請申請須知申請程序 : 請將下列文件交回本校 ( 麥當勞道 33 號 ( 請以 A4 紙張雙面影印, 並用魚尾夾夾起 : 填妥申請表並貼上近照小學五年級上下學期成績表影印本課外活動表現及服務的證明文件及