APPLICATION FOR MOE FINANCIAL ASSISTANCE SCHEME (MOE FAS)

Transcription

1 Annex A This form may take you 10 minutes to complete. Please read the following notes before you proceed to complete Section I to VIII. You will be required to submit supporting documents specified in Section III, together with this form. If you have children studying in different Government or Government-aided schools, you need to submit only 1 application form to the school of any child. APPLICATION FOR MOE FINANCIAL ASSISTANCE SCHEME (MOE FAS) OBJECTIVE 1. The objective of the MOE FAS is to help needy Singaporean students to meet basic schooling expenses. ELIGIBILITY CRITERIA 2. Pupil is a Singapore citizen, and meets one of the following income criteria: a. The family s gross household income (GHI) does not exceed $2,500 per month; or b. The family s per capita income (PCI) does not exceed $625 per month. PCI = Monthly Gross Household Income / No. of members in the household HOUSEHOLD INCOME 3. Household income is the total income of family members who stay in the same household. Gross income is income including regular allowances and employee's CPF contribution. Income from other sources (e.g. monthly pension, alimony and rental income) should be included as part of gross monthly income. 4. National Service allowance earned by NS men is not to be included in household income. Severance compensation and insurance payouts are also not to be included. 5. If the income earner is on no-pay leave for 6 months or less, he/she is not unemployed. His/her monthly income in months when she/he was not on no-pay leave should be assessed. 6. For pupils who have no parents and are staying with a legal guardian, the household income of the legal guardian would be considered. NEED NEW COMPUTER AT SUBSIDISED PRICE? 7. Pupils from low income households who wish to own a new computer at a subsidised price can apply for one under the NEU PC Plus Programme administered by the Infocomm Development Authority of Singapore (IDA). Under this Programme, each eligible household may apply for one computer once every 4 years, regardless of the number of school-going children and/or household members with permanent disability. 8. For parents who wish to apply, please indicate so in Section VII. If your application for MOE FAS is successful, the school will provide you a form to apply for NEU PC Plus Programme. 9. For details about the NEU PC Plus Programme, please visit or contact Tel: Updated: 4 Oct 2016 Page 1 of 6

2 APPLICATION FOR FINANCIAL ASSISTANCE SCHEME (MOE FAS)/(SAC FAS) SPRINGFIELD SESCONDARY SCHOOL Section I: Particulars of children studying in Government or Government-aided schools Please indicate the details of the child (or children if you have more than one school-going child) whom you wish to apply MOE FAS for. BC/NRIC No Name of Applicants (Full Name) Name of Current School* Class/ Level 2016 Class/ Level 2017 of Birth Citizenship Status (SC/PR) Home Address: Singapore ( ) HP(Parent) : HP(Student): Tel: Housing Type: 2 / 3 / 4 / 5 Rm / Exec / Pte / Others* (pls specify): Section II: Information on Other Household Members and Income (Please exclude the name of applicants) (a) Particular of Household Members Please include details of the parents, unmarried siblings and grandparents of the child if they are living in the same household. If the student is under the MSF Public Assistance Scheme or is a resident of an approved welfare home, there is no need to complete Section II if you can provide a copy of the MSF PAS pass or letter from the approved welfare home. S/N NRIC / Birth Cert No. Name of Family Members Occupation Gross Monthly Income Updated: 4 Oct 2016 Page 2 of 6

3 S/N NRIC / Birth Cert No. Name of Family Members Occupation Gross Monthly Income Gross Household Income Income should be reflected before CPF deduction. Income from other sources (e.g. monthly pension, alimony, rental income) should be included, but not the allowance for full-time National Service men. (b) For divorce cases: Are you receiving monthly maintenance allowance? (Pls Circle) Yes / No If Yes, please state the amount in (c). (c) Other Sources of Income Received by the Family (Eg, pension, alimony, rental income, if any) Source of Income Monthly Amount Total Amount Section III: Supporting Documents Please submit the following documents together with the application form. 1. Household members who are employed are required to submit their latest payslip or a letter from their employer certifying their Gross income. 2. Household members who are self-employed are required to attach their latest Income Tax Notice of Assessment. If the member is not required to pay tax or the tax assessment does not reflect his/her current income status, he is to complete the declaration at Annex A Household members who are unemployed and below age 62 are required to complete a declaration as enclosed in Annex A-1 and attach a copy of the CPF contribution history. Those who are undertaking full-time studies or are in full-time National Service are not required to do so. 4. Copies of NRIC for parents, copies of Birth Certificate for applicants and siblings to be attached. 5. Copy of (11-B) for household members who are serving NSF to be attached. 6. Copy of student matrix card or enrolment letter for household members who are undertaking full-time studies. 7. For divorcees, please submit: Copy of divorce certificate. Copy of Court Decree Order for Custody and Maintenance Allowance. 8. Copy of Death certificate is required for parent in the family who is deceased. 9. Any other documents as and when required by the school for the purpose of verifying the income. Updated: 4 Oct 2016 Page 3 of 6

4 Section IV: Request for Free Textbooks and School Attire If the application is successful, the child/children will enjoy waiver of school fees and standard miscellaneous fees, and will be eligible for free textbooks and school attire if they need. Please tick ( ) the below items if required. You may tick more than one box. Textbooks Uniforms (2 sets) PE attire (2 sets) Shoes (1 pair) Socks (2 pairs) Else, please tick ( ) the box below: My child/children does/do not need any of the above items. Section V: Modes of Transport between Home and School (Only for the child studying in Springfield Sec School) My child/children take(s) the following mode of transport between home and school (Please tick only one box) By Public Transport Subsidy of $240 per annum^ (MOE Subsidy - $120 + School Subsidy $120) By School Bus (Applicable to Primary level only) (Subsidy of 50% of the monthly fare) By Own Transport (No Subsidy) Walk to School (No Subsidy) Pro-rated from the month of FAS application approval to December of the same year Section VI: Request for School Meals Programme Subsidy ($3.50 per day) If the application is successful, the child/children will be eligible for School Meals Programme via emeal Coupon System. The fund for the Meals subsidy will be uploaded to the students Ezlink card for them to buy food at the School Canteen only. Please tick ( ) to indicate whether your child/children require the School Meals Programme Subsidy below: YES / NO If Yes, please take note that : Child/Children who are studying in Springfield Secondary School are required to submit their Student Ezlink Card to the School General Office upon receiving the MOE/FAS or SAC/FAS Approval Letter for the uploading of funds to the Ezlink cards. Name of Student Class School Ezlink Card Serial No. (Will be Input by school after the Student Ezlink Card has been scanned) Section VII: Apply for New Computer (Please read notes 7-9 on Page 1 carefully) I wish to apply for a new computer through IDA s NEU PC Plus Programme. I confirm that my family did not receive a computer under the IDA s NEU PC Plus Programme in the last 4 years. If my child/children are granted the MOE FAS, I consent to authorise the MOE to provide my household particulars, including my address, to IDA or its lead agencies for them to contact me for the application. Please place a tick ( ) accordingly. Yes, I would like to apply for new computer through IDA s NEU PC Plus Programme No, I don t wish to apply for new computer through IDA s NEU PC Plus Programme Section VIII: Declaration I,, NRIC No, hereby declare that the information provided above is true to the best of my knowledge. I undertake to refund the value of benefits received by my child/children if any of the information is found to be false later on. I accept that the school can request for additional information to assess the financial needs of my household and to reassess the financial assistance provided at any time during the course of the year. I understand that the information given by me in this form or any part thereof may be shared with other Government departments, statutory boards, or entities involved in the administration of social assistance, and I consent to this being done. Signature of Parent / Guardian Updated: 4 Oct 2016 Page 4 of 6

5 Section IX : To Be Completed by School Eligibility To be completed by FAS Processing Officer (FAS PO) Information on family members and income Complete / Incomplete Student's Citizenship Citizen / Non-Citizen Total No. of Family Members in Household / Monthly Gross Household Income / PCI / Eligibility Criteria for MOE/FAS Monthly gross income $2,500 or Per Capita Income $625 Benefits: Full waiver of school and standard misc fees Free textbooks, workbooks, writing materials and school attire MOE Transport Subsidy $20/month for students who take public transport to school from Jan Dec (MOE Subsidy - $120 + School Subsidy $120 per annum) School Meals Programme ($3.50/day) Eligibility Criteria for SAC/FAS* Per capita income $675 Benefits: Full waiver of school and standard misc fees Free textbooks, workbooks, writing materials and school attire School Meals Programme ( $3.50/day) *Only eligible for Springfield Sec Students Other Benefits: Subsidy on Other Teaching & Learning Materials / Programme (On a Case by Case basis) MOE FAS SAC FAS Student is eligible for INELIGIBLE FOR BOTH SCHEMES Remarks: Name & Designation Signature & Decision To be completed by the FAS Approving Officer (FAS AO) Decision on the Application Approved / Not-Approved Remarks: Mr Martin Chan / Mr Bambang Vice Principal Name & Designation Signature Update to ibens To be completed by ibens DEC and IBENS AO Authority Reference No Assigned Action Signature ibens DEC Grant updated to ibens ibens AO Grant approved/reflected in ibens Updated: 4 Oct 2016 Page 5 of 6

6 Annex A-1 DECLARATION OF UNEMPLOYMENT OR SELF-EMPLOYMENT Section A: Declaration of Unemployment I / We declare that I am / we are currently unemployed. Name of Household Member NRIC Period of Unemployment Example: (from Jan 2014 Oct 2016) Signature Section B: Declaration of Self-Employment Please note that self-employed household members with supporting income tax documents need not complete this section I / We declare that I am / we are currently self-employed and I am / we are not required to submit Income Tax Return or my / our latest Income Tax Notice of Assessment does / do not reflect my / our current income status. Name of Household Member NRIC Type of Employment Example: Part-time cleaner / Baby-sitter Current Income Signature Updated: 4 Oct 2016 Page 6 of 6