Gender. Male Female. Chinese Characters (if applicable) l l I / I I I / I I I I I Day Month Year

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1 FORM 4 APPLICATION FOR PERMANENT RESIDENCE IN SINGAPORE This application is for an Entry Permit under Regulation 4 of the Immigration Regulations You may apply for permanent residence while in Singapore or abroad This form may take you 20 minutes to fill in Affix a recent passportsized colour photograph of Applicant here PART A TYPE OF APPLICATION I am applying for the grant of an Entry Permit to enter and reside in Singapore as (select one only) I am the spouse/child of a Singapore Citizen I am the spouse/child of a Singapore Permanent Resident I am the parent of a Singapore Citizen Other reasons (please specify) PART B APPLICANT S PARTICULARS FIN No (if any) : I I I I I I I I I I Identification Type and No. (for Malaysians only) New ID No. : I I I I I I I - I I I - I I I I I Old ID No. : I I I I I I I I I Name in Travel Document. Please use BLOCK LETTERS (Underline Surname) Chinese Characters (if applicable) FOR OFFICIAL USE EP CATEGORY l l l l ENT/ I I I I I I I/ I I I Alias (if any) Nationality Race Religion (Denomination) 1. I I I I I I 2. I I I 3. I I I PASS TYPE : Province / State & Place of Birth Present Residential Address in Singapore Are you currently residing with the sponsor at the above address? Yes No How long have you been residing with the sponsor at the above address? years months (If the sponsor is your spouse and both of you are not living together, please provide reasons on a separate sheet of paper.) Marital Status 1. Occupation Salary per Month a) Basic : S$ b) Gross : S$ I acknowledge receipt of original documents presented for sighting Signature: Date: 2. Highest Academic Qualifications Attained (if different from item 3) 3. 1 st Degree, Type and Class (e.g., B.A.(Hons) 2 nd Upper / Diploma) Applicant s Children (if applicable) No. of children who are S pore Citizens l l l No. of children who are S pore Permanent Residents l l l No of children who have other nationalities l l l Type & Serial No. of Travel Document Held Date and Place of Issue Date of Expiry Address in Country of Nationality Page 1 of 7

2 PART B APPLICANT S PARTICULARS (CONTINUED FROM PAGE 1) LIST COUNTRIES AND ADDRESSES IN WHICH APPLICANT HAS RESIDED DURING THE PAST 5 YEARS (TILL PRESENT DATE) Period of Stay DD/MM/YYYY Address Country From To IF RESIDENT* IN SINGAPORE (LIST IN CHRONOLOGICAL ORDER) * any person who resides or had previously resided in Singapore by virtue of any immigration pass or permit or work permit. Dates of Arrival Dates of Departure Have you or has any one of the persons included in this application ever: (a) Been prohibited from entering Singapore or any other country? (b) Been asked/required to leave Singapore or any other country? (c) Been refused entry into or deported from Singapore or any other country? (d) Been convicted of or currently charged with a crime or offence in i) Singapore? ii) Any other country? If your answer is Yes to any of the above, please provide a detailed explanation on a separate sheet of paper. Have you or has any one of the persons included in this application ever entered Singapore using other Passports and different Particulars? If Yes, please state Name and : Type and Passport No: Date of Issue: Please provide detailed particulars of all passports used. IF THE APPLICANT IS THE SPOUSE OF A SINGAPORE CITIZEN OR SINGAPORE PERMANENT RESIDENT, PLEASE FILL UP THIS PART Did you provide money or any form of benefit, directly or indirectly to: (i) your spouse, your spouse s family or a third party in relation to the sponsoring of this application? (ii) your spouse, your spouse s family or a third party for agreeing to enter into this marriage? Did you enter into this marriage with your spouse to enable you to obtain long-term stay in Singapore? If your answer is Yes to any of the above, please provide a detailed explanation in a separate sheet of paper. Page 2 of 7

3 PART C PARTICULARS OF APPLICANT S SPOUSE (To be filled in only if applicant s spouse is not the local sponsor) FOR OFFICIAL USE FIN No (if any) : I I I I I I I I I I EP CATEGORY l l l l Identification No. (for Malaysians only) Applying for PR with you? ENT/ I I I I I I I/ I I I New ID No. : l l l l l I I I I I I I I I I Old ID No. : l l l l l l l l l l l Yes l l No Name in Travel Document in BLOCK LETTERS (Underline Surname) Chinese Characters (if applicable) Alias (if any) 1. I I I I I I Nationality Race Religion (Denomination) 2. I I I 3. I I I PASS TYPE : Province / State & Place of Birth Marriage Certificate No. Date of Marriage Country of Marriage Present Residential Address in Singapore 1. Occupation 2. Highest Academic Qualifications Attained (if different from item 3) Name of School / College/ University 3. 1 st Degree, Type and Class (e.g., B.A.(Hons) 2 nd Upper)/Diploma Salary per Month a) Basic: S$ b) Gross: S$ Type & Serial No. of Travel Document Held Date and Place of Issue Date of Expiry Present Whereabouts Note: if deceased, give date of death. Page 3 of 7

4 PART D PARTICULARS OF APPLICANT S PARENTS AND APPLICANT S CHILDREN BY THE PRESENT MARRIAGE Name in Travel Document in BLOCK LETTERS and FIN / ID Card No. Relationship Date of Birth (1) Race (2) Nationality (3) Country of Birth Travel Document Type Number Occupation Academic Qualification (e.g. B.A. (Hons) 2 nd Upper) Monthly Income Marital Status Country of Residence Applying For PR with you? (Yes/No) 1 Father 2 Mother PART E PARTICULARS OF APPLICANT'S ALL OTHER MARRIAGES (including customary marriages) AND CHILDREN (if not applicable please enter NA ) (1) Particulars of other marriages: Name of Spouse Place of Birth Date of Marriage Present Whereabouts *Date of Divorce/Decease (2) Particulars of all children (by all other marriages/illegitimate children/adopted children) : Name of Children Place of Birth *Name of Father/Mother Present Whereabouts Type Travel Document Number Applying for PR with you? (Yes / No) *Delete where applicable Page 4 of 7

5 PART F SPONSOR'S PARTICULARS FOR OFFICIAL USE Singapore Identity Card : *Pink / Blue I I I I I I I I I I * Delete where applicable Name in Travel Document in BLOCK LETTERS (Underline Surname) Chinese Characters (if applicable) Alias (if any) Nationality Race Relationship to Applicant Place of Birth Religion (Denomination) Marriage Certificate No. Date of Marriage Country of Marriage 1. Occupation Salary per Month (a) Basic: S$ (b) Gross: S$ 1. I I I I I I 2. Highest Academic Qualifications Attained (if different from item 3) 3. 1 st Degree, Type and Class (e.g. B.A. (Hons) 2 nd Upper / Diploma) 2. I I I 3. I I I PASS TYPE : 4. l l l 5. l l l Present Residential Address In Singapore Telephone No.: Hand phone No : Residential : Office : IF THE SPONSOR IS THE SPOUSE OF THE APPLICANT, PLEASE FILL UP THIS PART Did you or your family receive money or any other form of benefit, directly or indirectly from any person in relation to the sponsoring of this application? If your answer is Yes, please provide a detailed explanation on a separate sheet of paper. If the applicant is not the spouse of sponsor, please fill in this Part Name of Sponsor's Spouse 4. Highest Academic Qualifications Attained (if different from item 5) 5. 1 st Degree, Type and Class (e.g. B.A. (Hons) 2 nd Upper / Diploma) 6. Occupation Salary per Month (a) Basic: S$ (b) Gross: S$ Page 5 of 7

6 PART F SPONSOR S PARTICULARS (CONTINUED FROM PAGE 5) Particulars of Sponsor s All Other Marriages ( Including Customary Marriages) : Name of Spouse Nationality Place of Birth Date of Birth Date of Marriage Present Whereabouts *Date of Divorce/ Decease, where applicable Name of Children to be included in this application:- (1) (2) (3) (4) (5) (6) Affix recent photo(s) of children applying for Permanent Residence. (1) (2) (3) (4) (5) (6) Page 6 of 7

7 PART G DECLARATION OF APPLICANT I hereby make an application for the grant of an Entry Permit under Regulation 4 of the Immigration Regulations. I declare that the particulars stated from Parts A to E and the documents submitted with it are true and correct to the best of my knowledge and belief, and that I have not wilfully suppressed any material fact. I hereby give my consent to the use of the same set of thumbprints and photograph, submitted in respect of my application for immigration facilities, for the purpose of Identify Card registration, if applicable. I also hereby give my consent for your department to obtain and verify the information provided by me in respect of this application, from or with any source, as you deem appropriate for the purpose of assessment of my application for immigration facilities. Date Signature or Right Thumb Impression of Applicant PART H DECLARATION OF SPONSOR I declare that (a) the statements made by the applicant and myself in this application are true; and (b) the applicant is not, to the best of my knowledge and belief, a member of any political party which has been declared unlawful in Singapore. I also hereby give my consent for your department to obtain and verify the information provided by me in respect of this application, from or with any source, as you deem appropriate for the purpose of assessment of my dependant's application for immigration facilities. I understand that male children who are granted PR status under their parents sponsorship are liable for National Service (NS) under the Enlistment Act. All NS-liable males aged 13 years old and above, are required to obtain an Exit Permit (EP) when travelling overseas for 3 months or more. Renouncing or losing one's PR status without serving or completing full-time NS would have an adverse impact on any immediate or future applications to work or study in Singapore, or for Singapore citizenship or PR status. Date Signature or Right Thumb Impression of Sponsor WARNING IT IS AN OFFENCE UNDER THE IMMIGRATION ACT TO MAKE ANY FALSE STATEMENT, REPRESENTATION OR DECLARATION IN CONNECTION WITH THIS APPLICATION Page 7 of 7

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