(a) Have you ever been refused entry into or deported from any country/place, including Singapore? Yes No
(b) Have you ever been convicted in a court of law in any country/place, including Singapore? Yes No
(c) Have you ever been prohibited from entering Singapore? Yes No
(d) Have you ever entered Singapore using a different passport or name? Yes No
If any of the answer is “YES”, please furnish details below
I declare that all information submitted in this application is true, accurate and complete to the best of my knowledge and belief. I
understand that, if I have concealed relevant information or provided false, inaccurate or misleading information, I may be prosecuted
and any facilities, rights or privileges granted under this application may be withdrawn.
I undertake not to misuse controlled drugs or to take part in any political or other activities during my stay in Singapore which would
make me an undesirable or prohibited immigrant under the Immigration Act 1959.
I undertake to comply with the provisions of the Immigration Act 1959 and any regulations made thereunder or any statutory
modification or re-enactment thereof for the time being in force in Singapore.
I undertake not to involve in any criminal offences in Singapore.
I undertake not to indulge in any activities which are inconsistent with the purpose for which the immigration passes have been issued
I further undertake not to be engaged in any form of employment, business or occupation whilst in Singapore without a valid work pass
issued under the Employment of Foreign Manpower Act 1990.
I am aware that overstaying or working illegally in Singapore is a serious offence and on conviction, the penalties may include mandatory
imprisonment and caning.
I understand that if the Controller of Immigration is satisfied that I or any member of my family breaches this undertaking or becomes an
undesirable or prohibited immigrant, he will cancel my immigration pass and the passes of the members of my family, and we may be
required to leave Singapore within 24 hours of such cancellation.
I understand that this application for and possession of a visa does not guarantee entry into Singapore and permission to entry is entirely
discretionary at the point of entry.
I give my consent for your department to obtain and verify information from or with any source as you deem appropriate for the
assessment of my application for immigration facilities.
Date Signature of Applicant