MINISTRY OF EDUCATION FINANCIAL ASSISTANCE SCHEME (MOE FAS)

MINISTRY OF EDUCATION FINANCIAL ASSISTANCE SCHEME (MOE FAS) Please submit the following documents together with the application form S/ N TYPE OF DOCUMENTS FOR SUBMISSION TICK / NA 1 Photocopy of Birth Certificate / Citizenship Certificate (if applicable) of all children studying in K2 and all Government Schools. RECEIVED BY OFFICE 2 Photocopy of NRIC of both parents. 3 CPF Contribution history for the past six months for all household members aged 21 years to 62 years (COMPULSORY) 4 IRAS (latest Income Tax) 5 Divorce Cert/Custody Documents/Maintenance Documents 6 Household members who are employed are required to submit their latest payslip or a letter from their employer certifying their income. 7 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/she is to complete the declaration at Annex A-1. 8 Household members who are unemployed and below age 62 are required to complete a declaration as enclosed in Annex A-1 if they are not undertaking full-time studies OR are not in full-time National Service. 9 If the Total Gross Household Income in Section II, exceeds $2,500 and there are 5 or more members in the same household (including grandparents), please provide the following additional documents: a) Copies of NRIC of household members, other than parents and unmarried siblings. b) If there are other dependent children with no NRIC, please submit copies of legal documents to show that they are staying in the same household. 10 Any other supporting documents as and when required by the school for the purpose of verifying the income. MOE-FAS Application 2017/SMB

Annex A This form may take you 10 minutes to complete. Please read the following notes before you proceed to complete Section I to VI. 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. OBJECTIVE APPLICATION FOR MOE FINANCIAL ASSISTANCE SCHEME (MOE FAS) 1. The objective of the MOE FAS is to help needy Singaporean students to meet basic schooling expenses. ELIGIBILITY CRITERIA 2. Student 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 divided by the number 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 3 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 VI. If your application for MOE FAS is successful, the school will provide you a form to apply for NEU PC Plus Programme and help you to send the completed form to the lead agencies of IDA for processing and approval. 9. For details about the NEU PC Plus Programme, please visit www.ida.gov.sg/neupc or contact Tel: 6684-8858. Updated 15 Sep 2016/SMB Pg 1 / 7

MINISTRY OF EDUCATION FINANCIAL ASSISTANCE SCHEME (MOE FAS) APPLICATION FORM (This scheme applies only to Singaporean students in Government or Government-aided schools) 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. Form submitted to: (Name of School) Birth Cert/NRIC No. Full Name As In BC / NRIC #Current School 2016 2017 Home Address : Student HP: Father HP: Mother HP: Home No: Parent s Email: #Current school and level of the child/children is/are attending at the point of submission. Section II: Information on Other 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. NRIC/ Birth Cert.No. Name Age Marital Status Relationship to Pupil Father Mother Occupation Name of Company / School * Gross Monthly Income $ Total 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. Updated 15 Sep 2016/SMB Pg 2 / 7

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 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/she is to complete the declaration at Annex A-1. 3. Household members who are unemployed and below age 62 are required to complete a declaration at Annex A-1 if they are not undertaking full-time studies or are not in full-time National Service. 4. Any other documents as and when required by the school for the purpose of verifying the income. If the Gross Household Income in Section II (shaded in grey) exceeds $2,500 and there are 5 or more members in the same household, please provide the following additional documents: 5. Copies of NRIC of household members, other than parents and unmarried siblings. If there are other dependent children without NRIC, please submit copies of legal documents to show that they are staying in the same household. Section IV: Request for Free Textbooks and School Attire (For Primary and Secondary levels only) 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) Else, please tick ( ) the box below: Socks (2 pairs) My child/children does/do not need any of the above items. Section V: Modes of Transport between Home and 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 $120 per annum^) By Own Transport (No Subsidy) By School Bus (Applicable to Primary level only) (Subsidy of 50% of the monthly fare) Walk to School (No Subsidy) ^ Pro-rated from the month of FAS application approval to December of the same year. Section VI: Apply for New Computer (Please read notes 7 9 on Page 1 carefully,) Please place a tick ( ) in the box below if you wish to apply for a new computer. Please leave it blank if you do not wish to apply. 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 3 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. Section VII: Declaration I, (full name), 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 Date Updated 15 Sep 2016/SMB Pg 3 / 7

Annex A-1 DECLARATION OF UNEMPLOYMENT OR SELF-EMPLOYMENT Section A: Declaration of Unemployment I / We declare that I am / we are currently unemployed. Full name as in NRIC NRIC No. Period of Unemployment From (month-year) To (month-year) Signature of Household Member Date 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. Full name as in NRIC NRIC No. Type of Employment Current Income S$ Signature of Household Member/s Date Updated 15 Sep 2016/SMB Pg 4 / 7

TRANSPORT SUBSIDY For students studying in SEMBAWANG SECONDARY SCHOOL only. Does your child take public transport (bus / MRT) to & from school? Please tick ( ) only 1 box S/ N Full Name As In BC / NRIC Birth Cert/NRIC No. Current School 2016 2017 Yes No 1 SEMBAWANG SEC SCHOOL 2 SEMBAWANG SEC SCHOOL 3 SEMBAWANG SEC SCHOOL 4 SEMBAWANG SEC SCHOOL Name of Parent / Guardian: Contact No: Signature: Date: Updated 15 Sep 2016/SMB Pg 5 / 7

SEMBAWANG SECONDARY SCHOOL FINANCIAL ASSISTANCE SCHEME (MOE FAS) FREE ATTIRE (UNIFORM) APPLICATION FORM One form to be completed for one student. Please ask for additional forms if you have more than 1 child studying in Sembawang Secondary School. Birth Cert / NRIC No. Full Name As in BC/NRIC 2016 2017 Please tick ( ) UNIFORM SIZE Please write down the sizes AMOUNT SHIRT X 2 30-56 $ SKIRT X 2 22-46 $ SHORTS X 2 24-48 $ LONG PANTS X 2 24-48 $ To be completed by School CSO Signature of CSO : Date : School Stamp Student / Parent to sign AFTER COLLECTING the free attire from the Uniform Seller. Signature of Student/Mother/Father/Guardian TOTAL AMOUNT $ Name : Date of collection Updated 15 Sep 2016/SMB Pg 6 / 7

MOE FINANCIAL ASSISTANCE PROCESSING & APPROVAL FORM Particulars of children studying in Government / Government-aided schools Birth Cert/NRIC No. Full Name As In BC/NRIC School 2016 2017 Section V : 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 * No of member in the household Monthly Gross Household Income (GHI) $ If GHI > $2,500 Compute Per Capita (PCI) Income by Dividing GHI by No of members in the household ($ ) = $ (PCI) Eligibility for MOE FAS : (GHI $2,500) or (PCI $625) Eligible * / Not Eligible * $10.00 Transport Voucher ( Monthly ) Eligible * / Not Eligible * GHI includes income earned by ALL members of the household. It includes rental income, pension, alimony and income from other sources such as investments. Full-time National Service allowance should be excluded from the computation of GHI. Name & Designation Signature Date Decision To be completed by the FAS Approving Officer (FAS AO) Decision on the Application Approved * / Not Approved * (PCI > $625) Name & Designation Signature Date Update to ibens To Be Completed by ibens DEC and ibens AO Authority Reference No. Assigned Action Signature Date Grant updated to ibens ibens DEC Grant approved/reflected in ibens ibens AO Student informed of the outcome of application * Yes / No To whom : By whom : Date : * To delete whichever is inappropriate Updated 15 Sep 2016/SMB Pg 7 / 7