NRIC: Citizenship: Race: Sex: Date of Birth: Age: Marital Status: AAME/TWE Batch No.: Educational Level: Licence No.: Licence Expiry Date:

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1 Web site: Application for Ordinary Membership To: General Secretary, I wish to make an application for membership of SEEU. I hereby agree to abide by the Constitution of SEEU and to any additions and/or amendments as may from time to time be made to the Constitution. Staff No. Name: Affix your passport size photograph here Home Tel: Office Tel: Mobile: Address: Postal District: NRIC: Citizenship: Race: Sex: Date of Birth: Age: Marital Status: AAME/TWE Batch No.: Educational Level: Licence No.: Licence Expiry Date: Employer Date Employed: Date Confirmed: Occupation: Department/Division: Section/Shift Grade: Address: Name of Spouse: NRIC: Name of Father: NRIC Name of Mother NRIC Name of Child #1: Name of Child #2: Name of Child #3: Name of Child #4: Sheet 1 of 2 Form SEEU 01/2010

2 Are you at present a member of any other Trade Union?. Yes/No * If yes, Name of the Union Membership Number: I, the undersigned, hereby state that the particulars furnished by me herein before are true and correct to the best of my knowledge and herewith submit the sum of S$37.00 as payment of my Entrance Fee and One Month s Subscription in advance according to the rate below and my authorization in writing on the prescribed form for the check-off of all subsequent monthly subscriptions, levies and contributions. Date: Signature Name: Proposer: Signature Membership No.: Seconder: Signature For Office Use Only Application Accepted / Rejected by General Secretary on : Name: Membership No.: Subscription Fee: Entrance Fee: Total: For Month of: Effective Date of Check-off Receipt Number : Remarks: Signature of General Secretary Application Accepted / Rejected* by Executive Committee on : ENTRANCE FEE & SUBSCRIPTION RATES ENTRANCE FEE S$25.00 SUBSCRIPTION. $12.00 per month Sheet 2 of 2 Form SEEU 02/2010

3 Web site: AUTHORISATION FOR CHECK-OFF Membership No.: To: Senior Accountant, Payroll Through: General Secretary, SEEU 1) I wish to request you to deduct from my salary and annual wage supplement, where applicable, the following sums for my Union membership subscriptions and levies as follows :- (a) Membership subscription (b) Levies (13 th Month payment) NTUC Core Benefits Scheme Monthly deduction of S$12.00 per month Once a year deduction of S$ ) This request is valid for a period from 01 July 2010 to 30 June The amount deducted is to be sent to of which I am a member. If I wish to stop such deductions before the stipulated period, I shall inform you in writing through my Union giving you three months advance notice. The deductions should cease on the expiry of the notice period or as earlier as my Union may advise you accordingly. Name Signature/Date: Company Staff Number: SIAEC / ESA Division Department Witness Name Witness Signature/Date ENTRANCE FEE & SUBSCRIPTION RATES ENTRANCE FEE S$25.00 SUBSCRIPTION. $12.00 per month Form SEEU 03/2010

4 Web site: SEEU NAME CARD APPLICATION Name Division/Section Tel (Office) Office Address Mobile Address Form SEEU 04/2010

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