Declaration Form
This form must be submitted during pass issuance. If there are any discrepancies in this Declaration Form, the correct information must be provided using iSubmit at www.mom.gov.sg/isubmit before the collection of the pass. The application will be re-assessed and we will inform you of the outcome.
PART A DECLARATION BY FOREIGN EMPLOYEE
Name: RUSMECHOTIWAT NADESAI FIN: G3180590U
Date of Application: 10 JUN 2015 Date of Birth: 29 SEP 1985 Nationality: THAI
Educational details:
Country of Awarding Body/Institution/University: THAILAND
Name of Awarding Body/Institution/University: SUAN SUNANDHA RAJABHAT UNIVERSITY Main Campus or Affiliating College Attended: -
Qualification: BACHELOR'S DEGREE
Faculty: ARTS & SOCIAL SCIENCES
Mode of study: FULL-TIME
Period of study: 29 APR 2008 to 06 OCT 2011
Name of Employer/Sponsor: JAMCUTE PTE. LTD. Occupation: PERFORMING ARTISTE
Fixed Monthly Salary (S$): 2,500
I declare that:
● I have never been refused entry or deported from any country.
● I have never been convicted in a court of law in any country.
● I have never been prohibited from entering Singapore.
● I have never entered Singapore using a different passport issued by a different country.
● I have never entered Singapore using a different name.
● I have never been a citizen or permanent resident of Singapore.
● I have read and understood the conditions of S Pass in the Employment of Foreign Manpower (Work Passes) Regulations c.91A, available at MOM counters or at www.mom.gov.sg.
Declaration Details: Nil
I consent, for the purpose of assessing this Application for an S Pass and the administration of work pass matters,
● for the Government of Singapore and statutory authorities thereof to obtain from and verify information with any person, organisation or any other source, and further,