出国留学申请表

GED - 2009年新加坡留学

_________________________________________________________________________________________________________________Page 1 of 2 Student Enrolment & Admission (Admission Application form) FM-SEA-01-01/R1

Student’s particular is solely for the purposes of completing course submission.

学生个人资料仅限于申请报读课程的手续之用，请打印出来填写完整。

PART A – PARTICULARS OF APPLICANT

姓名：

Name 曾用名：

Alias 性别：

Gender 出生地点：

Place Of Birth

拼音：

Pin Yin 拼音：

Pin Yin 婚姻：

Marital Status 出生日期：

Date Of Birth

国籍：中国

Nationality 宗教：

Religion 种族：

Race 出生证号码：

Birth Certificate No.

居住地址：

Residence Address 联络电话：

Contact No.

通讯地址：

Correspondence Address 邮政编码：

Postcode

银行定期存款数额：

Fixed Deposit Amount 存款人姓名：

Name of Depositor

现用护照号码： 护照有效日期： 曾用护照号码（如有）：

Current P/P No. P/P Validity Date Previous P/P No. (if any)

就 读 学 校 名 称

Previous Name of Schools / Institute attended 入学时间

Entry Date 离校时间

Leaving Date 最高学历

Qualification Obtained

小学

Primary School:

初中

Secondary School:

高中

High School：

大学

University / College：

英文是否及格 (根据最近的成绩)

Obtained a pass in English (based on latest results):  及格 Pass  不及格 Failed

工作单位

Name of Company 职务

Position 任职时间

Duration 月收入 / 货币

Mthly Income / Currency

1.

2.

亲属

Family 姓名

Name 拼音

Pin Yin 性别

Gender 身 份 证/护照号码

I/C / Passport No. 出生日期

Date of Birth

父亲

Father

母亲

Mother

兄妹

Siblings

配偶Spouse

工 作 单 位 Name of Company 职务 Position 月收入 / 货币

Monthly Income / Currency

父亲 Father:

母亲 Mother:

配偶 Spouse

Photo

of Student

学生照片 留学申请表 Admission Application Form

申请大学 University Applied No. : 1)______________________2)__________________

读课 报读课程 Course Applied For :1)___________________2)_______________________

学生签名/ Student’s Signature: ______________________________ 日期/Date: ____________________

(Same Signature as in Passport跟护照里的签名一致)

GED - 2009年新加坡留学

_________________________________________________________________________________________________________________Page 2 of 2 Student Enrolment & Admission (Admission Application form) FM-SEA-01-01/R1

PART B – ANTECEDENT*/ 经历*

1. Have you ever been refused entry into or deported from any country?

你是否曾经被某个国家禁止入境或驱逐出境？ Yes/是  No/否

2. Have you ever been convicted in a court of law in any country?

你是否曾任何国家触犯过法律？ Yes/是  No/否

3. Have you ever been prohibited from entering Singapore?

你是否曾经被新加政府禁止入境？ Yes/是  No/否

4. Have you ever entered Singapore using a different Passport or Name?

你是否使用过其他护照或名字入境新加坡？ Yes/是  No/否

* If any of the answer is “YES” please furnish details on following or a separate sheet of paper 若以上任何一项答案为‘是’，请详细说明

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

PART C – DECLARATION BY APPLICATION 申请学生声明

I hereby declare that all the particulars furnished by me in this application are true and correct.

我谨此声明以上所提供的一切资料属实。如有不属实，愿承担法律责任。

学生签名 Student’s signature :_____________________日 期 Date:_________________________

(Same Signature as in Passport跟护照里的签名一致)

学生姓名 Student’s Name : ________________________

PART D – FOR APPLICATION SPONSORED BY LOCAL CITIZEN/ PERMANENT RESIDENT

（如果新加坡有担保人，则填写；如果没有，无需填写；不影响申请大学）

Sponsor name in BLOCK LETTERS:_______________________________________________________

Singapore NRIC No. Pink/Blue*: __________________________ Tel No:__________________________

Relationship to Applicant:_______________________ Sex: Male/Female*, Birth of Birth:______________

I hereby sponsor this application and certify that it is made for the purpose as stated by the applicant.

The statements made in this application are true and correct.

I shall be responsible for the cost of the applicant’s repatriation and maintenance pending such repatriation, if necessary.

Sponsor’s signature :_____________________ Date:_________________________

PART E – FOR CSE OFFICE USE ONLY（GED办公室填写）

1. Agent’s name, if any: _________________________________________________________________

2. Reconfirm applicant’s signature as indicated in the passport 确认学生签名跟护照里的签名一致

3. Other remarks 备注：

Dimensions Officer Name/signature（GED工作人员）签名：

Date日期：