Work Pass Division

18 Havelock Road Singapore 059764 Tel: 6438 5122 www.mom.gov.sg mom_wpd@mom.gov.sg

Long Term Visit Pass Application Form (Form 14)

This form may require you to take 20 minutes to fill in. You will need the following information to fill it: Note: The Employment Pass/EntrePass/PEP holders Foreign Identification Number and pass type The Long Term Visit Pass applicants Foreign Identification Number (if applicable) The Long Term Visit Pass applicants old/new Malaysian Identity Number (if applicable) The Long Term Visit Pass applicants Malaysian International Passport Number (applicable to Malaysian only) The Long Term Visit Pass applicants educational qualification and last drawn salary details

All relevant supporting documents (as stated in Annex A) must be submitted with this application. The application will be voided if inaccurate written information or wrong/unclear supporting documents is submitted. You will need to resubmit a new application. Please send your application by post to Work Pass Division, Ministry of Manpower, 18 Havelock Road, Singapore 059764. 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 The copy that you have downloaded more than 30 days ago may be outdated, and may not be used.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) 014/23022012

FORM 14 IMMIGRATION ACT [CHAPTER 133, SECTION- 55(1)] PASSPORT ACT [CHAPTER 220, SECTION 3(1)] APPLICATION FOR A LONG TERM VISIT PASS
INSTRUCTIONS: 1. For *, please tick () where appropriate. 2. Indicate Not applicable or N.A. where necessary. Do not leave any blank. 3. Please note that the processing time will take about 5 weeks. 4. Please send this completed application form with all relevant supporting documents by post to Work Pass Division, Ministry of Manpower, 18 Havelock Road, Singapore 059764. 5. You may check your application status online (http://www.mom.gov.sg>Services & Forms>Others>Application Status Check). For official use only: Date of Application:

Affix a recent passport-sized photograph here

Officer ID:

Remarks:

PART 1 APPLICATION INFORMATION 1A: Employment/S Pass Applicant / Holder Details

(Please enter either EP/S Pass FIN)

Foreign Identification No. (FIN):

(FIN No. held previously)

Name:
(as on travel document, excluding salutations, e.g. Mr, Miss, Professor, Doctor)

Alias:

Pass Type:*

PEP

EntrePass

EP

1B: Pass Declaration Is the Long Term Visit Pass applicant a Singapore Citizen or Singapore Permanent Resident?* Please provide the FIN/Work Permit/S Pass No. if the applicant had ever
I. applied for or worked in Singapore on an Employment Pass/S Pass/Work Permit II. studied in Singapore on a Students Pass III. stayed in Singapore on a Dependants Pass/Long Term Visit Pass

Yes

No

Long Term Visit Pass Foreign Identification No.: (FIN No.

held previously)

Work Permit No./S Pass No.:

(WP/S Pass No. held previously)

1C: Pass Duration Duration of Pass Applied for:

(months from 1 to 60 months)

1D: Relationship with Employment/S Pass Applicant / Holder Relationship:*

Daughter (Unmarried) above 21 years of age Handicapped Child above 21 years of age Step Child -1-

Parent Parent-in-law Spouse (Common-law)

MOM (WPD) 014/23022012

PART 2 APPLICANTS PERSONAL INFORMATION 2A: Personal Particulars Name:

(as on travel document, excluding salutations, e.g. Mr, Miss, Professor, Doctor)

Alias:

Name in Chinese Characters (If applicable): Sex:* Marital Status:*

Female Divorced

Male Married Separated Single Widowed

Date of Birth: (DD-MM-YYYY) Nationality: For Malaysian only: Malaysian Old Identity Card Number: Malaysian New Identity Card Number: Malaysian Identity Card Color:* Country of Birth: State/Province of Birth: Country of Origin:
(country where the person obtained his first citizenship by birth or parentage)

Blue

Pink

State/Province of Origin: Race:* Religion:*

Caucasian Buddhist Others

Chinese Christian Sikh

Indian Free Thinker Taoist

Malay Hindu

Others Muslim

2B: Travel Document Information Travel Document Type:* Travel Document No: Date of Issue:
(DD-MM-YYYY)

Hong Kong Special Admin Region International Cert of Identity

International Passport Macau SAR Travel Permit

Date of Expiry:
(DD-MM-YYYY)

MOM (WPD) 014/23022012

-2-

2C: Residential Address in Singapore Is the foreigner currently staying in Singapore?

No. You do not need to provide any more details Yes. Please fill in the address below: Postal Code: Block/House No: Floor No: Unit No:

Street Name: Building Name:

_______________________________________________________________________________ _______________________________________________________________________________

PART 3 APPLICANTS EDUCATION / LAST DRAWN SALARY DETAILS 3A: Educational Qualifications
(Please fill in details of the highest qualification attained)

Highest Qualification Attained (e.g. No Formal Education, Junior School, High School, Bachelors Degree, Doctorate, etc):

Country of School:

Name of School:

3B: School Enrolment

(Note: If there are any changes or updates to the applicants school enrolment in future, please update us of the details by writing to the Work Pass Division, Ministry of Manpower.)

Is the applicant planning to study or currently studying in an educational institution in Singapore?

(excluding pre-school, nursery and kindergarten)

Yes

No

(If No, please proceed to section 3C on Last Drawn Salary Details)

Enrolment Status:

Planning to Enrol

Enrolled

Name of School in Singapore:

Level of Education (e.g. No Formal Education, Junior School, High School, Diploma, University, etc):

Estimated Start Date:

(MM-YYYY)

Estimated Completion Date:

(MM-YYYY)

3C: Last Drawn Salary Details

Please provide the salary details of your current/last held employment (if any).

Gross Monthly Salary

(in Singapore Dollars)

S$

.00

MOM (WPD) 014/23022012

-3-

PART 4 DECLARATION BY APPLICANT

[For Long Term Visit Pass applicant who is a child 16 years and below, one of the parents is required to sign on the childs behalf.] Please tick () accordingly.

(a) Have you ever been refused entry into or deported from any country? (b) Have you ever been convicted in a court of law in any country? (c) Have you ever been prohibited from entering Singapore? (d) Have you ever entered Singapore using a different passport issued by a different country? (e) Have you ever entered Singapore using a different name? (f) Have you ever been a Singapore Citizen or Singapore Permanent Resident? (g) Have you ever stayed in Singapore? If Yes, please provide the most recent details below. Year(s) Month(s)

Yes Yes Yes Yes Yes Yes Yes

No No No No No No No

(i) Length of Stay (ii) Purpose of Stay

Accompanying Relatives Study and Work

Business Work

Leisure Others Yes

Study

(h) Has the applicant ever been issued a work visa by another country(s)? If Yes, please provide the most recent details below.

No

(i) Country of Issue: ______________________________________________________________________________ (ii) Length of Visa: Year(s) Month(s)

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

I hereby declare that all the particulars furnished by me in Part 1 3 and 4(a) (h) are true and correct. I undertake not to misuse controlled drugs or to 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. I undertake to comply with the provisions of the Immigration Act and any regulations made there under or any statutory modification or re-enactment thereof for the time being in force in Singapore. I undertake not to involve in any criminal offences in Singapore. I undertake not to indulge in any activities which are inconsistent with the purpose for which the immigration passes have been issued I further undertake not to be engaged in any form of employment, business or occupation whilst in Singapore without the written consent of the Controller of Immigration. I am aware that overstaying or working illegally in Singapore is a serious offence and on conviction, the penalties may include mandatory imprisonment and caning. I understand that if the Controller of Immigration is satisfied that I or any member of my family breaches this undertaking or becomes an undesirable or prohibited immigrant, he will cancel my immigration pass and the passes of the members of my family, and we may be required to leave Singapore within 24 hours of such cancellation. I understand that this application for and possession of a visa does not guarantee entry into Singapore and permission to entry is entirely discretionary at the point of entry. I give my consent for your department to obtain and verify information from or with any source as you deem appropriate for the assessment of my application for immigration facilities.

Date

Signature of Applicant

MOM (WPD) 014/23022012

-4-

PART 5 DECLARATION BY LOCAL SPONSOR

[Local sponsor must be the same as that of Work Pass application.]

We hereby sponsor this application and certify that it is made for the purpose as stated by the applicant. The statements made by the applicant in this application are to the best of our knowledge true. We undertake to 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. We shall keep copies of the documents/ certificates showing the relationship between the main Pass Holder and the applicant for as long as the main Pass Holder is in my employment. We 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.

__________________________
Authorised Signature / Date

_______________________________
Official Stamp of Company / Firm

___________________________
Name & Designation/Capacity

Tel No:

Fax No:

___________________________
Name & Address of Company

PART 6 DECLARATION BY WORK PASS APPLICANT / HOLDER IN SUPPORT OF APPLICATION FOR A LONG TERM VISIT PASS I declare that all the information as set out in Part 1 3 and 4(a)-(h) is, to the best of my knowledge, true and correct. I understand that I may be prosecuted if I have provided any information, which is false in any material particular, or misleading by reason of the omission of any material particular. I undertake to be responsible for ensuring the compliance by the applicant of any quarantine and medical surveillance imposed on the applicant under regulations 8 (2A) of the Immigration Regulations.

_________________
Date

_________________________
Signature of Work Pass Applicant / Holder**
(Employment Pass / EntrePass / Personalised Employment Pass applicant or holder)

** Delete whichever is not applicable

MOM (WPD) 014/23022012

-5-

CONSENT

With reference to my application submitted on.. for Long Term Visit 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 application.

Dated.of..20

(Name of Applicant)

(Signature)

* * (Passport / Identity Card No.)

** Delete which ever is not applicable.

MOM (WPD) 014/23022012

-6-

WORK PASS DIVISION

DID YOU REMEMBER?

ANNEX A

1 set of original application form duly completed. Application form signed by applicant. Application form signed by authorised officer from sponsoring company, and stamped with companys stamp or seal. 1 CLEAR COPY of the following supporting documents*:
(*Non-English documents must be accompanied by an official English translation done by a certified translator, High Commission/Embassy or a notary public.)

Travel Document Page showing the personal particulars and travel document number. Please include pages reflecting amendments to details (e.g. name, expiry date), if any. Documentary proof for one of the relationships between applicant and Main Pass Holder, as stated in the application: (a) Common Law Spouse Letter from Main Pass Holders respective Embassy or High Commission confirming the status of common-law marriage or Statutory Declaration of common law relationship Court Order on the child's custody or Letter of No Objection from both biological parents for the child to be brought to Singapore Birth Certificate Letter or report from a medical practitioner showing his assessment of the childs medical condition Main Pass Holders Birth Certificate Main Pass Holders Marriage Certificate and Birth Certificate of Main Pass Holders Spouse

(b) Stepchild

(c) Unmarried Daughters above 21 years old (d) Handicapped Children above 21 years old (e) Parent (f) Parent-in-law

Please do not submit original documents unless otherwise stated. Note: Any person who falsely declares salary, academic qualifications, or submits forged documents in the work pass application shall be guilty of an offence under the Employment of Foreign Manpower Act (Cap.91A).

MOM (WPD) 014/23022012

-7-