application for re-election re-election form 2020.pdfactions been taken against me by the icsa...

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APPLICATION FOR RE-ELECTION

FOR OFFICIAL USE ONLY

Date Received:

Tabled at the CFS Membership Committee Meeting held on:

DD/MM/YYYY

Application Fee Received: By Cheque

*tick where applicable Issuing Bank:

Cheque No.

NETS

Cash

Amount Paid: S$ Tax Invoice No.: Y /

Certificate Issued Date:

*ACIS/FCIS/Grad.ICSA Number:

*ACIS/FCIS/Grad.ICSA Number:

Name of Applicant: ___________________________

FOR OFFICIAL USE

FOR OFFICIAL USE

Re-election Application Form

ICSA Singapore Division Page 1 of 12

V01.2020

I. PERSONAL PARTICULARS

Salutation: *Mr/Ms/Mrs/Mdm

Name of Applicant:

(as per identity card)

Name should be written in full and underline the family name.

*Last 4 digits of

NRIC/FIN No.:

Date of Birth: DD/MM/YYYY

Status: *ACIS/FCIS/Grad.ICSA

Membership No.: Date of Admission:

*Delete where applicable

Residential Address:

S ( )

Telephone (Res): Mobile:

Personal Email

Address:

Employing

Organisation:

Designation:

Office Address:

S ( )

Office No.: Fax No.:

Office Email

Address:

Preferred mailing address: Personal Office Please tick where applicable

Preferred email address: Personal Office Please tick where applicable



V01.2020

II. REASON FOR LAPSED MEMBERSHIP

- Please indicate the reason for lapse of membership in the box below, and attach any

relevant supporting documents.

Lapsed since:

_________________________ to confirm with the Secretariat

III. REASON FOR RE-ELECTION - Please indicate the reason for re-election in the box below, and attach any relevant

supporting documents.



V01.2020

IV. EMPLOYMENT HISTORY

- Please provide your full career history from the year of lapsed membership in chronological

order, starting with your CURRENT employment.

- If you have had any promotions and/or re-designations during any of your employment(s),

please include them as separate entries.

*The referee in each case has to be a senior officer in the organisation concerned. The referee

is asked to certify from personal knowledge that the information, given by the applicant in the

section next to the referee’s signature, is correct. The referee is invited to provide any remark

or amplification considered relevant, in a supporting letter.

CURRENT EMPLOYMENT

Name of Organisation:

Job Designation:

Effective Period: DD/MM/YYYY

(From) (To)

Referee’s Name: Designation:

Signature of Referee and Date Company Stamp

PAST EMPLOYMENT(S)


Job Designation:


(From) (To)

Reference Letter/Testimonial Referee





V01.2020


Job Designation:


(From) (To)




Job Designation:


(From) (To)




Job Designation:


(From) (To)



(If the page is insufficient, please photocopy an additional sheet to complete)



V01.2020

V. PRESENT ANNUAL INCOME RANGE Please tick where applicable.

VI. FURTHER AND/OR HIGHER EDUCATION

- Please provide a copy of the relevant certificate/degree and transcript attained from the

year of lapsed of membership until present (where applicable).

Institution Period of Study

Full-time or Part-time Certification Obtained/

Degree Awarded From To

VII. OTHER PROFESSIONAL QUALIFICATIONS OBTAINED

- Please state the other professional qualifications you have attained from the year of lapsed

of membership until present (where applicable).

Name of

Professional

Organisation

Period of Study Full-time

or Part-

time Study

Designatory

Letters

Date Elected to

Membership

Membership

Number From To

VIII. ACTIVE INVOLVEMENT IN ACTIVITIES OR RELATED

PROFESSIONAL MATTERS

Up to S$15,000 S$15,001 – S$25,000 S$25,001 – S$50,000

S$50,001 – S$75,000 S$75,001 – S$100,000 S$100,001 – S$150,000

S$150,001 – S$200,000 S$200,001 and above



V01.2020

IX. SPONSOR’S RECOMMENDATION

NAME OF APPLICANT (IN BLOCK LETTERS)

I, , having known the above name for

(full name)

years and months, hereby recommend *him/her, as a fit and proper

person for re-election as *Graduate/Associate/Fellow of ICSA Singapore Division.

Full Name Organisation/Designation

Signature/Date Company’s Rubber Stamp

*delete where applicable.

X. DECLARATION Please verify that all fields are correct and tick all boxes.

I hereby apply for re-election as a *Graduate/Associate/Fellow of The Institute of Chartered

Secretaries and Administrators, Singapore Division.

I agree to pay all prevailing fees and subscriptions for which I become liable.

I undertake to be bound by

- the prevailing provisions of the ICSA Charter and Bye-Laws, and

the ICSA Singapore Division’s prevailing Regulations.

In support of my application, I furnish the particulars on pages 1 to 6 herewith and enclose

S$ _________________ in payment of the following:

Re-election Fee $525.00 #Outstanding Subscription #Current Subscription

TOTAL (incl prevailing GST rate ) #to be confirmed by the Secretariat

I hereby confirm that all details given in this application form are true and correct as at the

date of application.

(continued on the next page)



V01.2020

To support my application for re-election to *Graduate/Associate/Fellow, I make the following

declaration in terms of my character and standing:

Yes No

1. I am not an undischarged bankrupt and my affairs are currently not subject to

any arrangement with creditories or other external administration or any such

proceedings which are pending against me.

2. From the year of lapsed membership until present, I have not been convicted of

any offence of such nature that, if I had been a member of the ICSA Singapore

Division at the time, would have been likely to have given rise to disciplinary

actions been taken against me by the ICSA Singapore Division under its

Regulations.

3. From the year of lapsed membership until present, I have not been conducted

myself, whether by act or default in a manner that, if I have been a member of

the ICSA Singapore Division at the time, would have been discreditable to the

ICSA Singapore Division having regard to the Code of Professional Ethics and

Conduct.

(if the answer to any of the above is No, please provide further information.)

Full Name of Applicant Signature of Applicant Date

XI. PERSONAL DATA POLICY

The Institute of Chartered Secretaries and Administrators Singapore Division

Personal Data Policy

In compliance with the Personal Data Protection Act 2012 (“PDPA”), we seek your consent to collect

and use your personal data for the purpose of maintaining the register of members and participate in

the events organised by ICSA Singapore Division and to promote courses and/or events which may

be relevant to you, and to disclose such personal data to affiliated organisations where necessary

(“Purposes”).

We will provide you with details of upcoming events, seminars, workshops, conferences and training

programmes organised by ICSA Singapore Division and its affiliated organisations, and to provide

you with information of other promotions which may be relevant to you (“Services”).

I hereby give my acknowledgment and consent to ICSA Singapore Division to use my personal data

for the aforementioned purposes and services. In the event that I have registered with the Do-Not-

Call Registry and wish to withhold or withdraw my consent to ICSA Singapore Division, I will also

endeavour to provide sufficient notice to ICSA Singapore Division as soon as reasonably practicable.

________________________ ________________________ _____________________

Full Name of Applicant Signature of Applicant Date

~~END OF FORM~~

NOTE: Please note that incomplete applications received will not be tabled at the Membership Committee

meeting unless substantiated with the appropriate information as requested by the Secretariat.



V01.2020

RE-ELECTION TO

MEMBERSHIP/GRADUATESHIP

NOTES FOR THE COMPLETION OF THE FORM



V01.2020

NOTES FOR THE COMPLETION OF THE FORM Please read the following notes before completing the form. If you have any queries about any aspect of your application, or would like to discuss it informally before filling in the form, please call the Secretariat at 63344302 or send an email to [email protected] for advice. Refer to the checklist on pages 11 and 12 when filling in the application form to ensure you have provided all the necessary information for your application.

(A) CRITERIA Associates or Fellows who have lapsed their membership for a period of two (2) years (exclusive of the current year) and above are required to apply for re-election should they wish to re-instate their membership. The reason for lapse of membership and the employment history of the lapsed period of membership should be stated clearly in the application form with any supporting documents to substantiate.

(B) CHARACTER AND STANDING The term “fit and proper” contained in Bye-laws relates directly to the character of an applicant and includes the concepts of honesty, solvency and competency. However, the Membership Committee does not link the term “fit and proper” to a subjective view an applicant may hold of his/her own conduct and methods. As a result, the Membership Committee requires all applicants to answer the statements 1 to 3 of the declaration on page 6 of the application form as to his/her character. The Institute’s Charter obliges it to supervise the standard of professional conduct provided by its members and it is important to emphasise that the examples given below are not intended to be exhaustive or definitive, the concept of “fit and proper” is inherently open-ended. Question 1 This relates directly to the solvency of the applicant and includes a sequestration order,

compromise or deed of arrangement with the applicant’s creditors.

Question 2 This relates to: a) any offence involving fraud or other dishonesty under legislation (whether or not in

Singapore) relating to companies, building societies, credit unions, friendly societies, insurance, banking or other financial services, insolvency, consumer credit or consumer protection; and/or

b) any other offence not in (a) above including criminal convictions, in a civilian or military

court, involving fines, suspended sentences or terms of imprisonment. This may exclude non-criminal traffic offences.

Question 3 This relates to: a) disqualification by court, other statutory or regulatory body from acting as a director

of a company, or from acting in the management or conduct of the affairs of any company, partnership, incorporated and/or unincorporated association; and/or

b) disciplinary actions including criticism, censure, fine or exclusion from membership of

any professional body or organisation (whether or not in Singapore).

mailto:[email protected]



V01.2020

(C) INCORRECT OR MISLEADING INFORMATION If information is revealed to be inaccurate or misleading before and / or after re-election, then the application will be rejected and the applicant shall be subject to disciplinary actions.

(D) SPONSOR’S RECOMMENDATION Applicants for re-election must be recommended by a senior officer of the organisation of the current employment.

(E) REASON FOR LAPSE AND RE-ELECTION The reason for lapse of membership and re-election must be clearly stated in the application form.

(F) EMPLOYMENT HISTORY (1) You are required to give A DETAILED EMPLOYMENT HISTORY (completing this on additional

sheets if necessary). This should cover the period from the year of lapsed membership until the present, with any gaps of more than six (6) months being accounted for.

(2) You are required to provide a company reference letter that states the job scope of your

employment as a supporting document. Please note that these must show the post/s held and dates (i.e. month and year) of staffing and finishing. (Letters merely offering the post, or confirming a regrading are insufficient for this purpose).

(3) Please note the following with regard to the individual sections of this page of the form: Note of organisation In the case of a holding company, a group, or subsidiary companies, it

is important to specify the particular company in which you hold office.

Designation If the duties performed are not self-evident from the title, an outline of duties should be attached.

Dates Month and year to be given.

(G) SUBMISSION OF APPLICATION (1) Please check the website on the closing date of submission of application.

(2) Applications must be submitted by the closing date.

(3) Applications received after the closing date will be tabled at the next meeting of the Membership

Committee.

AN EXTRACT OF THE ICSA BYELAWS ARE AS FOLLOWS: Re-electing members 15.1 To be re-elected as a member, a person must comply with the byelaws, and any other conditions

that the Council decides to require on a case by case basis.



V01.2020

Checklist for Re-election Applications To assist the Secretariat with processing your application, please complete the following checklist. Incomplete applications received will not be submitted for approval unless substantiated with the appropriate information as requested by the Secretariat.

Items Indicate “✓” when completed

1. Fees Payable

i. Current, outstanding and election fee is enclosed.

(Cheque to be made payable to “CSIS”. Please indicate your full name and “Re-election Fee” at the back of the cheque).

2. Signature of Applicant

i. Answered, signed and dated in sections X and XI on pages 6 and 7 of the application form.

ii. Any amendments to the information as provided in this form has to be countersigned and dated.

3. Employment History

i. Full career history from the year of lapsed membership to date has to be provided in chronological order, starting with the most current employment.

ii. Any promotions and/or re-designations during any employments should be stated in separate entries.

iii.

For the current employment, to ensure that the referee has duly signed, dated and stamped on the relevant entries.

Past employments may be certified by either of the following methods:

- Signature of the referee duly dated, along with the company stamp

- Reference letters: stating clearly the position(s) held and the exact dates of starting and ending.

iv. Business profile from ACRA of the organisation of your current employment is enclosed.

v. Any employment entry without certification should be supported with an explanatory letter.

vi. Any gaps in between employments of more than 6 months should be addressed in section IV on pages 3 and 4 of the application form.



V01.2020

Items Indicate “✓” when completed

4. Educational and Professional Qualifications

i. Educational and professional qualifications attained are to be listed in chronological order in sections VI and VII respectively on page 5 of the application form.

ii. Certificates and transcripts for both educational and professional qualifications are enclosed.

5. Active Involvement in Activities

i. Any information stated in section VI on page 5 of the application form should be substantiated with the appropriate supporting documents (if any).

6. Sponsors’ Recommendation

i. The sponsor must be senior officer of the organisation of the current employment.

THE COMPLETED FORM AND SUPPORTING DOCUMENTATION, SHOULD BE SENT TO:

149 Rochor Road #04-05 Fu Lu Shou Complex Singapore 188425

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