ROC/REN

lnstructionsPtrRSCINAL PARTICULARS TORM

This forrn may take you approxirnately 30 minutes 1o cornplete.Male applicants art required to tomplete all sections (Section I to fiection V) of the form. !'emale applicantsare only rcquired to complete Section I and Section II of thc form.Please fully cumplete the re<;uired sections in the form. lf any item is not applicablc, the space should be filledwith ttNil" 0r t'N"A.t'.

Any omissions or errors in cornplcting thc fornr will result in delays of procmsing your case.Kindly sign and date at the end eif the frrrm.

I. PERSONAL PARTICUI.ARS

TI. T'ORNIGN DOCUMENTS

* Oeletc where not npplicable

PPI; I Rev I l0 5082008 I REN I IU Sectkxt

t.2.

3.

4.J.

NAME: RACE & IIEI.IGION:

ADI}RIISS:

CONTACTNO. / EIITAIL:

MARITAI, STATUS

SINGLIT / MARRIED / WIDOWED IDIV{'ITCED *

SEX:

MALE I FEMALE*

SINGAPOR"E NRIC NO. PRESIINT OCCUPATION

DATE OF', $IRTII (DD/MM/YYYYI: PI-ACE OF BIRTH ITIRTH CERT. NO.I CITIZENSHII'NO;

SINGAPORE I}ITERNATTONAL /RI'STRICTE} FASSPORT NO.:

PT,ACN OF ISSUI{: DAT}I OF ISSUE & ITXPITTY:

MONTH & YEAROTDEPARTURE TROM SINGAPORE

PRESENT I{ATIONAL SIIRYICE STATUS :

RBGISTI{.ANT I }'ULL.TI} H SIIRV ICEIIIAN/RT,SERYIST I PART.I'IMESERVICEIVTAN / EXAKIp|I'EI} I ]YOT APPLTCAI}I,E *

CITIZENSHIP CERTIFICA] E NO : I'I.ACE OT'ISSUE DATIi OT' REGISTIiATION

}'ORBTGN PASSPORTNO: PI-ACE OT ISSUE DATII OT ISSUEI EXPTRY

I,'OREIGN IDEN:I'IFICIA"I'ION CARDNO. (ifany):

PI-ACE OF ISSUE: DATE OF ISSUE (STAI'E EXPIRY I}AI'Itr,IFAVAILAITI,F])

ROCIREN

I'or male applicant, kindly till in the remaining sections {Sectinn III to Y) of the form.

III. EI}UCATION

IV.I'M use additional sheets if

LevelYNAR Qualilicatinn

obt*ined SchouUlnstitution & Countryr.ROM TOa. Primary

b. Secondary

c. Terliarry ( GCE "A"I.evels I Iliploma)

d. Degrees

e. Others

I}EITIOD OF EMFLOYMENTS/No. POSITION HBLD CONII'ANY & COUNTRY t"RoM

(rlr)/Mtur/YYYY)TO

(DDiMM/YYYY}SALARY

l\)F filev l 0 5 082AAA I REN / I U S ec tion

ROC/RENY. TA]\{[Y BACKGROUND use additional sheets if

I declare that to the best of my knowledge, the above information is correcl

Name: Date:

-

l{hether ASingapore

CitizenPrevious

Date OfRenunciationOf SingaporeCitizenship

OccupationCurrenl Country Of

ResidencePlace Of Birth Date Of BirthSiugapore Birth

Certi{icate / CitizenshipCertilicate No.

Current CitizenshipSingapore NRICNo.Name

Father

Mother

Ilusband l l{ife

Son

Daschler

Brothem

Sisters

P P F I Rev 1 I 05 082008 I RE N I IU S ectiort

signature-

lmmigration & Checkpoints Authority

Dear Sir / Madam,

RENUNCIATION OF SINGAPORE CITIZENSHI P

We wish to advise you to consider carefuily before you renounce your Singaporecitizenship. Once your declaration of renunciation is registered, you cease to be a citizen ofSingapore and there is no provision for reinstatement, There is also no assurance that you cancontinue studying, working or residing in Singapore as a foreigner on any form of student pass,work pass, socialvisit pass or as a permanent resident.

2. lf you are a male citizen, we would also like to inform you that under Article 128(2) ofthe Constitution of the Republic of Singapore, the Government may withhold an application forrenunciation of Singapore citizenship of a person if he is subjected to the Enlistment Act andhas not discharged his National Service liability. lf you are allowed to renounce your Singaporecitizenship without the need of completing your National Service liability, there will be anadverse effect on your immediate or future application of any forms of work /student passesand visa entry into Singapore.

3. Kindly acknowledge receipt of this note and return it to us after you have signed it

Yours faithfully

ASSISTANT REGISTHARSINGAPORE

This is a computer generated letter. No signature is required

Acknowledge by: Name of Applicant :

Signature ;

NRIC No. :

Date :

f ns'pirc'x6 {-*rfielrrace lri ".1

JJ

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MINDEFSINCAPORI

Dear Sir,

RI'NUNCIATION OT SINGAPORD CITIZENSI{T

1. National Service (NS) is vital to the delence and security of Singapore. Under theEnlistment Act, male Singapore citizens and Permanent Residents are liable for NS.

2. We would like to inform you that under Articl e 128(2) of the Constitution of the Republicof Singapore, the Government may withhold a person's application for renunciation of Singaporecitizenship if he is subjected to the Enlistment Act and has not discharged his NS liability.

3. Those who are allowed to renounce their Singapore citizenship without serving NS willface serious adverse consequences in their immediate or future applications to work, study or livein Singapore. They will not be granted Permanent Resident status or citizenship in the future.

4. For further enquiries, please contact the Ceutral Manpower Base at 1800-3676767 or email:contact@ns.sg

Yours sincerely,

Commander

Central Manpower Base

I read and acknowledged the information provided in this note.

Name of Applicant / NRIC Signature / Date

I

STATUTORY D ECI..{RATIO N

(ntme) (Singapore NRIC No. \r

I

1

-)

(residential address)

(occupation), do solemnly, and sincerely declarc:

I am olsound mind,

I was born on (date o[ birlh) in (country ol hirth),'

I am a Singapore citizcn (S tsirth Ccrtificatc / Singaporc Citizcnship Certificate / Singapore NRIC No.

4 I am also or ahout to becomc a citizen of (narnc of othcr country),{

fl'ara 5 to be completed anly by a woman under ?l year.s o[d who has becn mnrried]

5 I was married 0n ***.- (dd/mmiyyyy.t,

6 To the trest of my knowledge and belief the statsments givcn in this statutory declaration arc true andcorrect,

To the best of rny knowlcdge and bclief thc documonts I have tendered in support of my statemonts aregenuine documcnts, and

I hercby renounce my citieenship of Singuporc.

And I makc this solernn dcclaration by virtue of thc i:r:ur.isions of thc Oaths and fleclaration Act (Cap211), and subjcct to the penalties providcd hy that Act {irr the making of false statements in staturorydeclaration, conscientiously helieving the stalemcnts containcd in this declaration to bc true in everyparticular.

fleclared al

I

.... of(locationJ (day) imonth) {year)

Beftrre rnes,

Signatu rc erf declaranl Justice of the Fcacc.lCornmissioner lbr Oirths 1

Notary Public

NRIC to be produced lor verification.Declarant to be above 21 years old, unless she is a woman who has hr-:r:rr crarri*d, in which ca$e par&,5 is to be filled in antlher marriagc cer{ificate prod uced.Proof of Singapore citizenship to tre produced. Plcasc fill in either the, Sinliiipr"rre Birth Cerrificarc / Singapore CitizenshipCertificalc / Singapore NRIC No.Proof of foreign citizenship to bc produccd.Signature of official must be aculmpanied by an oflicial seal / stalnp alllxed i Appoinrmcnt lct{.cr and an official date $tamp.

I

2

3

.{

5

lmmigration & Checkpoints Authority

DURATION OT'COOLING OFF PERIOI)

I do not requirc any cooling off period

I require one month of cooling off period

If we do not hear from you byrenunciation of Singapore citizenship application.

we will proceed with your

Name

Signature

NRIC No

Dato

I rtspii ng t onfide *c e r* ;3 J,r

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lmmigration & Checkpoints Authority

QUESTIONATRE rOR SINCAPOREAN Wr r0 RENOIINCL{ CITTZBNSHII}

Please complete questionnaires and return it to this Registry together with your Declaration forRenunciation of Singapore Citizenship.

Name :

NIIIC No :

Date :

Ouestionnairc

1. What are your reasons for having emigrated or wanting to emigratc? (l'lease select only 3 boxesas the most important reasons and rank them in ordcr of importance, with 1 indicating most important)

High cost of living in Singapore

Singapore is too regulated anrl stilling

Better career / business prospect overseas

Better and less stressful education opportunities for your children

Prefer a more relaxed lif'estyle

To be reunited with close family members who emigrated earlier

Do not want your son(s) tr: serve National Servicc

Retirement abroad

Marriage to a foreign national

Uncertain future of Srirgapore

Others (please specify)

Why are you renouncing your Singapore citizenship I (Please select one or more boxcs)

Same as above

To take up citizenship of another country

To take up permanent residence of another countt l,

To withdraw CPF funds

Othcrs (please specify)

How long have your been living away from Singapore?

l,ess than 5 years

5 - 10 years

> 10 years

Not Applicable

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ELIMINATION FINGER FRINTS

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ROLLEP I},IPRESSIONS OF RI6HT HAND

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