Work Pass Division

18 Havelock Road Singapore 059764 Tel: 6438 5122 www.mom.gov.sg [email protected]

Employment Pass / S Pass Appeal Form

This form may require you to take 10 minutes to fill in. You will need the following information to fill it: The applicants Foreign Identification Number The employing companys Unique Entity Number* (UEN) The employing companys Registration No. (ACRA) < if applicable> If you wish to be considered for an S Pass, you will need the employing companys CPF Submission Number (CSN)#
* This is a standard identification number issued to each organisation in Singapore, to facilitate their interaction with various government agencies. For more information on UEN and UEN issuance agencies, please refer to www.uen.gov.sg # This refers to the number meant to replace your old CPF Account Number. It consists of your companys/organisations UEN + CPF Payment Code, and is either 14 or 15 digits/characters in length. For more information on CSN, please refer to www.cpf.gov.sg or call CPF Call Centre at 1800-227-1188.

Note: MOM regularly updates its forms. The copy that you have downloaded more than 30 days ago may be outdated, and may not be used. To ensure that you use the latest version, please download the latest copy at http://www.mom.gov.sg

MOM (WPD) 24062011

Work Pass Division

APPEAL FOR EMPLOYMENT PASS OR S PASS / REQUEST FOR CHANGE OF PASS TYPE (FOR SAME EMPLOYING COMPANY ONLY)
Note : 1. 2. For , please tick () where appropriate. Please submit electronic/scanned copies of this form and the following supporting documents (if any) via the iSubmit web portal (http://www.mom.gov.sg/iSubmit). For this mode of submission, please select 1. Assessment of EP/ S Pass/ DP/ LTVP/ EntrePass/ PEP/ WHP/ TEP under Request Type on the iSubmit portal. Applicants education/ professional qualifications Supporting documents from the relevant vetting agencies/ professional bodies/ accreditation agencies. Do not fax the Appeal Form. The processing time for reviewing appeals is at least three weeks. Please note that incomplete forms will not be processed.
#

3. 4. 5.

PART I : TYPE OF APPEAL / REQUEST Please tick one of the following boxes: (a) Appeal for Rejected (b) Request for Upgrade of Existing Pass Application: to: - Employment (P/Q)/ S Pass* - Q1 - P2 - P1
* Your appeal will only be considered for the pass type you have previously applied for. (For S Pass holders requesting to upgrade to Employment Pass, please use the SelfAssessment Tool (http://sat.mom.gov.sg/) for a preliminary indication of the eligibility before submitting the request.)

(c) Request for Downgrade of Existing Pass to: - Q1 - P2

PART II : APPLICANTS PARTICULARS Our Reference No. : Date of Application :

S Pass/WP No. :

FIN :

Name of Applicant :

Nationality:

Date of Birth :

PART III : COMPANYS PARTICULARS Name of Company: Companys CPF Submission No :

1

Address of Company:

Registration No. (ACRA):

Unique Entity Number (UEN):

PART IV : JUSTIFICATION FOR APPEAL Details of justification2:

1 2

: Compulsory for applicant appealing for an S Pass : Please attach necessary documents for the justification, e.g. income tax assessment form, salary slips etc. 1

MOM (WPD) 008A2/24062011

PART V : APPLICANTS EDUCATION & PAST EMPLOYMENT DETAILS [ Please complete Part V & Part VI (i) if there is any amendment to the information declared in original application ] i. EDUCATIONAL DETAILS Educational Details (1) Country of Awarding Body/ Institution/University: Name of Awarding Body/ Institution/University: Main Campus or Affiliating College Attended: Qualification : Faculty: Specialisation: Mode of Study#: Period of Study:
(DD-MM-YYYY)

Full-Time
From

Part-Time

Distance Learning
To

Educational Details (2) Country of Awarding Body/ Institution/University: Name of Awarding Body/ Institution/University: Main Campus or Affiliating College Attended: Qualification : Faculty: Specialisation: Mode of Study#: Period of Study:
(DD-MM-YYYY)

Full-Time
From

Part-Time

Distance Learning
To

ii. WORKING EXPERIENCE Total period of working experience: Total period of relevant working experience: iii. Please tick () accordingly. I declare that:Yes a. b. c. d. e. f. g. Have you ever been refused entry or deported from any country? Have you ever been convicted in a court of law in any country? Have you ever been prohibited from entering Singapore? Have you ever entered Singapore using a different passport issued by a different country? Have you ever entered Singapore using a different name? Have you ever been a Singapore Citizen or Permanent Resident of Singapore? Have you ever stayed in Singapore? If Yes, please provide the most recent details below. (i) (ii) Length of Stay: Purpose of Stay: Year(s) Month(s) No Years Years Months Months

Accompanying Relatives Leisure Study and Work Others

Business Study Work

h.

Have you ever been issued a work visa by another country? If Yes, please provide the most recent details below. (i) (i) Country of Issue: Length of Visa: _____________________________________ Year(s) Month(s)

If any of the above answers from (a) to (g) is Yes, please provide details: _____________________________________________________________________________________________ _____________________________________________________________________________________________

MOM (WPD) 008A2/24062011

PART VI : NEW EMPLOYMENT DETAILS i. Occupation:

__________________________________________________________________________

(Refer to the List of Standard Occupation available on MOM website)

Fixed Monthly Salary (S$): Basic Monthly Salary (S$): PART VII : DECLARATION BY APPLICANT [ To be completed if Part 1 (b) Request for Upgrade of Existing Pass is selected ] I confirm that the information as set out in my Application for S Pass and this Appeal for upgrade to Employment Pass is to the best of my knowledge, true and correct. All documents submitted in support of this appeal for upgrade to Employment Pass are true copies of the originals. I understand that I may be prosecuted if I have provided any information which is false in any material particular, or is misleading by reason of the omission of any material particular. In the event that this appeal is successful, I am fully aware that my subsequent renewal applications/appeals will be subjected to the prevailing work pass conditions at the point of renewal. I have read and understood the Conditions of Employment Pass, as specified in the Employment of Foreign Manpower (Work Passes) Regulations, which are available on the MOM website. I shall ensure that these conditions will be complied with. In addition, I hereby declare that: 1. I shall not make any false statement or submit any document which I know to be false in order to obtain a work pass and visit pass. 2. I understand that if I breach any condition above, my work pass and visit pass will be revoked and I can be prosecuted in Court, or expelled and prohibited from entering Singapore. 3. I shall not misuse controlled drugs or 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.

With reference to this appeal for upgrade to Employment Pass and residence in Singapore, I give my consent to the Government of Singapore to obtain from and verify information with any person, organization or any other source for assessing my appeal. I hereby give my consent for the Comptroller of Income Tax to verify my income stated in my current and renewal applications, based on my assessment record for the current Year of Assessment, for the Controller of Work Passes. In the event my assessment record for the current Year of Assessment is not available or finalized at the point of verification, I understand the Comptroller of Income Tax will verify my income against my assessment record for the two previous Years of Assessment. I also hereby give my consent for the Comptroller of Income Tax to thereafter communicate the results of the verification to the Controller of Work Passes.

(Name / Signature of Applicant)

(FIN / Date of Signature)

MOM (WPD) 008A2/24062011

PART VIII : DECLARATION BY EMPLOYER I, (Name of authorised representative) ____________________________________________________________ (NRIC No./FIN No.) ___________________________________________________________________________ in my capacity as (Designation in company/firm) ____________________________________________________ of (Name of company/firm) _____________________________________________________________________ whom is the employer and local sponsor of the applicant confirm that the information as set out in the application for Employment/S Pass and this appeal, as well the attached documents (if any), are to the best of my knowledge, true and correct. I have ensured that the applicant fully understands the contents of Part VII of this appeal form. I understand that I may be prosecuted if I have provided any information which is false in any material particular, or is misleading by reason of the omission of any material particular. I further understand that any false statement made by my company or myself in relation to this application and appeal for an Employment/S Pass may adversely affect the future work pass applications of my company/firm. I am aware that the Controller of Work Passes uses my company/ firms Central Provident Fund (CPF) contribution information to determine the number of local workers employed by my company/firm hence determining the number of foreign workers that my company/firm may employ. I am also aware that by signing this Form, I am declaring that 1. 2. my company/firm only makes CPF contributions to Singapore citizens or permanent residents who are actively employed by my company/firm; and my company/firm is making employer CPF contribution to each local employee at the prescribed rate specified by law (see the First Schedule of the Central Provident Fund Act) and any voluntary CPF contributions are made through a separate CPF Submission Number (CSN).

I undertake to: (i) (ii) (iii)

be responsible for the stay, maintenance and repatriation of the applicant; indemnify the Singapore Government for any charges or expenses which may be incurred by the Government in respect of the repatriation of the said applicant or any of his dependants; and be responsible for the compliance by the applicant of any quarantine and medical surveillance imposed on the applicant under Regulation 8 (2A) of the Immigration Regulations.

In addition, I declare that: 1. 2. 3. I hereby give my consent to the department to verify the particulars with any government agencies. The company owner(s) is/are not undischarged bankrupt(s). I **have/have not used the services of an Employment Agency or intermediary based in Singapore for the recruitment of the foreign worker. (Please also state the licence number of all Employment Agencies or intermediaries (if any) used for the purposes of this application: _______________________________________. Please ensure that a copy of Part IX of this form is completed by each Employment Agency or intermediary used.) I have not been offered or received (directly or indirectly), any sum or other benefit: (a) as consideration or as a condition for employing the foreign employee; (b) as consideration or as a condition for continuing to employ the foreign employee; or (c) as a financial guarantee related, in any way, to the employment of the foreign employee.

4.

In the event that this appeal is successful and the application for Employment/S Pass is approved, I shall keep copies of the applicant's education certificates as declared in the Application/Appeal Form for as long as the applicant is in my employment. I understand the Ministry of Manpower can at any time request for these documents for verification and revoke the pass should the documents be inconsistent with the declaration furnished in the application form or if I am unable to produce the documents. I have read and understood the Conditions of Employment/S Pass, as specified in the Employment of Foreign Manpower (Work Passes) Regulations, which are available on the MOM website. I shall ensure that these conditions will be complied with. I understand that if I breach any of the above conditions, I may be prosecuted. Further, the Controller may revoke the **S Pass and Visit Pass of the S Pass holder / Employment Pass and Visit Pass of the Employment Pass holder, and such breaches will be taken into account in considering my future work pass applications. I declare that I have read and understood the above.

(Signature of Authorised Representative) (Date of Signature)

**Delete where inapplicable Note: Controller mentioned in the above declaration means the Controller of Work Passes. MOM (WPD) 008A2/24062011 4

(Company / Firm Stamp)

PART IX : DECLARATION BY THE EMPLOYMENT AGENCY/INTERMEDIARY [ Applicable for appeal for an S Pass and if the employer has used the services of an employment agency or intermediary ] (If more than one Employment Agency or intermediary is used, please download and complete another 'Declaration By Employment Agency or Intermediary' form from MOM website.) Name of Employment Agency/intermediary: Licence Number (For Employment Agency only): Registered Address:

I declare that the abovenamed employer has not been offered (directly or indirectly), any sum or other benefit: (a) as consideration or as inducement for employing the foreign employee; (b) as consideration or as inducement for continuing to employ the foreign employee; or (c) as a financial guarantee related, in any way, to the employment of the foreign employee.

Name and NRIC Number of Authorised Representative

Signature of Authorised Representative

Date

Official Stamp of Employment Agency/Intermediary

PART X : DECLARATION BY THIRD PARTY [ Applicable for appeal for an S Pass and if the third party is submitting the application on behalf of the employing company ] I declare that this appeal was submitted by my company on the instruction of the employing company. I further declare that I have ensured that all the details on the Pass Holders salary, occupation, work experiences and qualifications as set out in the Appeal Form are provided to my company by the employing company. My company has documentary proof of this in the form of hardcopy application forms signed by the employing company and will retain them for one year from the date of this application for the inspection by the Controller. I understand that my company may be prosecuted if we have provided information which is false in any material particular, or is misleading by reason of the omission of a material particular. I understand that any false statement and/or declaration made by my company or myself in relation to the Appeal for the S Pass may adversely affect the future work pass applications made by my company.

I declare that the above details on the Pass holders salary, occupation, work experiences and qualifications are true and accurate.

Name and NRIC Number of Authorised Representative

Signature of Authorised Representative

Date

Official Stamp of Third Party

Note: Controller mentioned in the above declaration means the Controller of Work Passes.

MOM (WPD) 008A2/24062011