*0 36604573*

WP No.
WP Sk

: 0 36604573
: 6 ( 851A )

17/07/2014
LAKSHMI D/O GOVINASAMI
506 BUKIT BATOK STREET 52
#02-79
SINGAPORE 650506
Dear Sir / Madam

Work Pass Division

Ministry Of Manpower
18 Havelock Road
Singapore 059764
Telephone : (65) 64385122
Facsimile : (65) 65387275
Website : http://www.mom.gov.sg
Email
: mom_wpd@mom.gov.sg

WP ONLINE

*036604573160714*
IPA No. : 036604573160714
SB Transmission Ref No. : V037934

Foreign Worker
: SUBBURAJ KALIYAMMAL
Nationality : INDIAN
Date of Birth : 18/05/1975
Date of Application
: 16/07/2014
Passport No. : L8783589
Letter of Notification to bring Foreign Domestic Worker (FDW) into Singapore
Your application to employ the foreign worker named above has been approved in-principle. The approval is valid for 3 months from
16/07/2014 . You can bring the worker into Singapore anytime during this 3 month period. Within the first 3 working days of the domestic
worker's arrival (excluding the day of arrival), she is required to i) submit an acceptable educational certificate at the test centre
before she is allowed to attend the Settling-In Program (SIP) ii) complete the Settling-In Program (SIP). The failure to meet these
requirements will result in the revocation of this Approval.
Entry Visa
2
The Controller of Immigration has approved a Single-Journey Entry Visa for this worker. She will be issued with a Visit Pass and the
Visa when she receives her work permit card.
Security Bond & Personal Accident Insurance
3
You are required to:
(a)
execute a Security Bond for this foreign worker. The Security Bond should be backed by a security deposit of $5000 in
the form of a banker's/insurance guarantee valid for 26 months, made out in favour of the "Controller of Work Passes".
The security bond must be electronically transmitted by your bank/insurance company at least 1 working day before
the foreign worker arrives in Singapore. Otherwise, the foreign worker will be refused entry. (Please read the overleaf for
important information on the Security Bond).
(b)
take up Personal Accident Insurance (PAI) for the domestic worker of an insured sum of not less than $40,000 and
must be valid for at least 26 months. In the case of injury or death of the worker, any money payable under the insurance
policy as compensation must be paid to the domestic worker or her beneficiaries.
Medical Insurance
4
You are required to purchase and maintain Medical Insurance for your foreign worker's inpatient care and day surgery. For medical
insurance policies taken up or renewed on or after 1 Jan 2010, the insurance coverage must be at least S$15,000 per year per foreign worker.
The insurance details must be transmitted to MOM before you apply for a work permit to be issued. This should have been done by your bank
or insurer. You may check if this has been done via the WP Onine Service. If the insurance details have not been transmitted, please provide
the information when requesting the issuance of the work permit via WP Online.

Temporary Work Permit

5
We have approved a temporary work permit for this worker to allow her to begin employment with you. The temporary work permit
will start upon the worker's completion of the requirement within the first 3 working days of her arrival in Singapore, as specified in
Paragraph 1.
Payment of Levy
6
The current levy rate is $120.00 a month, or $3.95 a day for part-month employment. Please note that as a condition of this
approval, you have to pay the levy through GIRO deduction. The levy due each month will be deducted through the GIRO on the 17th day of
the following month. If the deduction cannot be made on the due date because your bank account has insufficient funds, a penalty will be
charged. If you have not made GIRO arrangements, your domestic worker's work permit will be revoked and you will have to repatriate her.

7
The levy will commence on the 5th day of the worker's arrival in Singapore. You are advised to pay the Foreign Worker Levy
promptly at all times. If you fail to do so, your worker's Work Permit will be revoked by the Controller of Work Passes.
Medical Examination
8
The domestic worker is required to be examined before the issuance of work permit by a Singapore registered doctor who should
complete the attached form.
Cancellation of Existing Domestic Worker's Permit
9
This worker is approved to replace your existing domestic worker. Your existing worker's permit must be cancelled on or before the
day the new worker's permit is issued. Otherwise, the new worker's permit cannot be issued and she has to be repartriated.
Submission of Documents to Process Work Permit
10
You need to apply for the issuance of work permit via WP Online within 14 days of the foreigner's arrival in Singapore. Otherwise,
the foreigner would have overstayed in Singapore and is liable to be fined/prosecuted. This in-principle approval will also be revoked.
Conditions and Regulatory Conditions of Work Permit
11
The employer and domestic worker must abide by the Conditions and Regulatory Conditions of Work Permit and the provisions in
the Employment of Foreign Manpower Act (please see www.mom.gov.sg). Failure to do so may result in the revocation of the Work Permit.
The employer may also be prosecuted and barred from future work permit applications.

12

Please take some time to read the detailed information overleaf and follow the submission procedures carefully.

Yours faithfully,
Controller of Work Passes
(As this is a computer generated letter, no signature is required)

FIWPS112Eu

GUIDELINES FOR EMPLOYERS WITH FOREIGN DOMESTIC WORKERS ARRIVING FROM OVERSEAS
Security Bond / $5,000 Security Deposit and Personal Accident Insurance for the domestic worker (not less than $40,000)
You can purchase the banker's / insurance guarantee for the security deposit at any insurance company or bank which provides the
service. You have to do so at least 1 working day before the foreign worker arrives in Singapore. The original Letter of Notification
to bring Foreign Domestic Worker (FDW) into Singapore and the completed security bond form must be presented during the
purchase. The effective date of the guarantee must be on or before the day the foreign worker arrives.
You may check if the security bond has been transmitted successfully via the WP Online service (click under 'Enquire > Security
Bond Status'). You may do so after 1 working day from the transmission by your bank / insurance company.
Please ensure that the foreign worker carries a clear copy of this letter upon his / her arrival in Singapore and presents it for
immigration clearance.
Issuance of New Work Permit Via WP Online (Before applying for the Issuance of Work Permit, please ensure that the worker's original
passport / travel documents is valid for at least 7 months)
You can apply for the issuance of work permit electronically via WP Online. You need to obtain a SINGPASS (Singapore Personal
Access) to access the WP Online System under "Services & Forms" at the MOM's website at http://www.mom.gov.sg. This is a
password that is required for transactions involving the Government's e-services. For more information on the SINGPASS
application, please visit the eCitizen's website at http://www.eCitizen.gov.sg. To apply for Issuance of work permit via WP Online,
select [Issue Work Permit] from the side menu. After you have submitted the application to WPD, you will be informed via WP Online
the outcome of your application on the same working day. However, application submitted after 8 pm (Mondays to Fridays) and after
2 pm (Saturdays) will be considered as submitted on the next working day. Issuance Services will not be available on Sundays and
Public Holidays. If your application is successful, you can print the Notification Letter via WP Online.
Procedures For An Employer Who Is Replacing An Existing Domestic Worker With A Worker Arriving From Overseas
The employer must cancel the work permit of the existing worker within 14 calendar days of the arrival of the new worker in
Singapore. If the existing worker is to be repatriated, her work permit must be cancelled.
If your existing worker is to be transferred to another employer, the new work permit must be issued to that employer (i.e. the
current permit under your name is cancelled) before you can submit the documents to process your new worker's permit.
Cancellation of Work Permit Via WP Online
You can cancel the work permit electronically via WP Online.To cancel work permit via WP Online, select [Cancel Work Permit] from
the side menu. After you have submitted the cancellation to WPD, you will be informed via WP Online the outcome of your
cancellation on the same working day. However, cancellation submitted after 8 pm (Mondays to Fridays) and after 2 pm (Saturdays)
will be considered as submitted on the next working day. Cancellation Services will not be available on Sundays and Public Holidays.
If your cancellation is successful, you can print the Acknowledgment Letter via WP Online.
You can cancel the existing domestic worker's work permit on the same day before requesting for the issuance of the new
worker's permit via WP Online.
Medical Examination
If the worker is certified medically unfit for employment, the work permit will not be issued and the employer has to send the worker
home. You can cancel the in-principle approval via WP Online by selecting "Cancel" function from the side menu.
Documents To Be Retained By Employer For Subsequent Verification By WPD
Original Letter of Notification to bring Foreign Domestic Worker (FDW) into Singapore
Immigration Form 12B

FIWPS112Eu

APPLICATION FOR A WORK PERMIT FOR A DOMESTIC WORKER

USER ID

13C6638

USER NAME

WPNO

0 36604573

DOA

S & A CONSULTANTS PTE.

LTD.
16/07/2014

TYPE OF APPLICATION :

NORMAL APPLICATION

DATE / TIME

17 July 2014 01:27 PM

PART I PERSONAL PARTICULARS OF FOREIGN DOMESTIC WORKER AND EMPLOYMENT

NAME
DATE OF BIRTH
NATIONALITY
STATE / PROVINCE where the

:
:
:
:

SUBBURAJ KALIYAMMAL
18/05/1975
INDIAN
TAMIL NADU

MARITAL STATUS
RACE
MALAYSIAN OLD IC NO.
TRAVEL DOCUMENT NO.
TRAVEL DOCUMENT EXPIRY
DATE
ENDORSEMENT TYPE
SALARY
PLACE OF EMPLOYMENT

:
:
:
:
:

MARRIED
INDIAN

:
:
:

SUPPORT AUTHORITY

NOT IN SINGAPORE
$350
506 BUKIT BATOK STREET 52
#02-79
SINGAPORE 650506

foreigner obtained his / her nationality

L8783589
20/04/2024

*03660457316072014*
PLACE OF BIRTH
STATE / PROVINCE OF BIRTH

:
:

INDIA
TAMIL NADU

SEX
:
RELIGION
:
COLOR OF IC
:
MALAYSIAN NEW IC NO.
:
TRAVEL DOCUMENT TYPE
:
FIN
:
EDUC
:
LONG TERM VISIT PASS EXPIRY :
DATE

FEMALE
HINDU

NAME OF EMPLOYER

LAKSHMI D/O GOVINASAMI

PLACE OF MARRIAGE
NATIONALITY
IC NO. (SC / SPR)
DATE OF SPR ISSUANCE
MALAYSIAN NEW IC NO.

:
:
:
:
:

PASSPORT
SECONDARY 3

PARTICULARS OF FOREIGN DOMESTIC WORKER'S SPOUSE

WORKER MARRIED TO SC / SPR
: NO
NAME
DATE OF MARRIAGE
DATE OF BIRTH
RESIDENTIAL STATUS
COLOR OF IC
MALAYSIAN OLD IC NO.
TRAVEL DOCUMENT NO.

:
:
:
:
:
:
:

PART I (A) CONDITIONS OF WORK PERMIT FOR FOREIGN DOMESTIC WORKER

DECLARATION BY FOREIGN DOMESTIC WORKER

I declare that (a) I have read and understood the applicable conditions of work permit, as specified in the Employment of Foreign Manpower (Work Passes)
Regulations c.91A, available at www.mom.gov.sg.
(b) I have had a minimum of 8 years of formal education and possess the necessary certificates as documentary proof of such education (applicable if
the foreign domestic worker has not worked as a foreign domestic worker in Singapore before).
(c) I have / have never* been convicted in any country or state of an criminal offence (if applicable, please provide details).
*Delete accordingly
(d) The information as set out in PART I is true and correct; and that all documents I have submitted in support of this Application for a Work Permit are
true copies of the authentic documents.

Signature Of Foreign Domestic Worker

Date:

FIWPS550

(DD-MM-YYYY)

Page 1 of 3

PART II PROSPECTIVE EMPLOYER

PARTICULARS OF THE DOMESTIC WORKER WHO IS TO BE REPLACED
NAME
GOVINTHARAJ KAVITHA

WP NO.

0 36392800

PURPOSE OF APPLICATION: REPLACEMENT

TP REQUESTED UPON SUBMISSION?:
CHANGE OF EMPLOYER:
IS CONSENT GIVEN FOR TRANSFER?:
NAME OF CURRENT EMPLOYER:
PARTICULARS OF EMPLOYER AND SPOUSE

MARITIAL STATUS : : WIDOWED

NAME
SEX
DATE OF BIRTH
NATIONALITY
RESIDENTIAL STATUS
IC NO. (SC / SPR)
PASSPORT NO.
FIN
DIPLOMAT ID
EXPIRY DATE OF DIPLOMAT ID
MALAYSIAN OLD IC NO.
MALAYSIAN NEW IC NO.
IS THE MARRIAGE REGISTERED IN
SINGAPORE WITH REGISTRY OF
MARRIAGES / MUSLIM MARRIAGES?
ADDRESS
TYPE OF RESIDENCE
OCCUPATION
NAME OF COMPANY
RESIDENTIAL TEL NO.
HP NO.
EMAIL ADDRESS
GIRO APPLICATION NEEDED?
PROCLAIMED MONTHLY / COMBINED
MONTHLY INCOME
IRAS AUTHORISATION? NO
MONTHLY INCOME
MONTHLY COMBINED INCOME
TYPE OF SUPPORTING DOCUMENT
AMOUNT
SINGAPORE INCOME TAX REF NO.
ANNUAL INCOME
YEAR OF ASSESSMENT

EMPLOYER
LAKSHMI D/O GOVINASAMI
FEMALE
01/01/1927
SINGAPORE CITIZEN
SINGAPORE CITIZEN
S0427769D

SPOUSE

506 BUKIT BATOK STREET 52

#02-79
SINGAPORE 650506
HDB (3 ROOMS)
HOUSEWIFE
62972123
NS.DAVID@YAHOO.COM.SG
NO
$0 - $1,999

PARTICULARS OF EMPLOYER'S FAMILY MEMBERS

NUMBER OF FAMILY MEMBERS
NUMBER OF CHILDREN

NUMBER OF AGED

BELOW 6 YEARS OLD

6 - 12 YEARS OLD

ABOVE 12 YEARS OLD

UNDER / EQUAL TO 60 YEARS OLD

ABOVE 60 YEARS OLD

NOTE: Only family members staying in the same residential address as employer are listed

BC / IC / FIN / PASSPORT NO.

FIWPS550

RELATIONSHIP WITH EMPLOYER

DATE OF BIRTH

Page 2 of 3

PART II (A) DECLARATION BY EMPLOYER

WP NO.: 0 36604573
NAME OF WORKER: SUBBURAJ KALIYAMMAL
NAME OF EMPLOYER: LAKSHMI D/O GOVINASAMI

DOA: 16/07/2014

CONDITIONS AND REGULATORY CONDITIONS OF WORK PERMIT FOR EMPLOYER OF FOREIGN DOMESTIC WORKER
I declare that (a)
I have read and understood the applicable conditions and regulatory conditions of work permit, as specified in the Employment of Foreign
Manpower (Work Passes) Regulations c.91A, available at www.mom.gov.sg.
(b)
I consent, for the purpose of assessing this application, for the Government of Singapore and statutory authorities thereof to obtain from and
verify information with any person, organisation or any other source; and further, to the release of all information thereby obtained to the
Government of Singapore, statutory authorities and authorised agents thereof.
(c)
To the best of my knowledge, the foreign domestic worker (if she has not worked as a foreign domestic worker in Singapore before) has had a
minimum of 8 years of formal education and possesses the necessary educational certificates as documentary proof of such education.
(applicable if the foreign domestic worker is not recruited through an Employment Agency).
(d)
I am not related to the foreign domestic worker.
(e)
I have ensured that the foreign domestic worker fully understands the contents of PART I and that it was signed by the foreign domestic worker.
(f)
I have / have not* used the services of an Employment Agency based in Singapore for the recruitment and / or application of a work permit for
this foreign domestic worker.
*Delete
(if applicable: Employment Agency Licence No._____________________________________. Please also ensure that the Employment Agency
accordingly completes PART III.)
(g)
The information as set out in PART II and any appeals I have made in relation to this application are , to the best of my knowledge, true and
correct; and that all documents submitted in support of this application and any appeals made in relation to this application, are true copies of
the authentic documents.

Name of Employer:

Signature of Employer:

NRIC / Passport Number:

Date:

(DD-MM-YYYY)

PART III PARTICULARS OF EMPLOYMENT AGENCY

IS AN EMPLOYMENT AGENCY / INTERMEDIARY USED FOR THE PURPOSES OF THIS APPLICATION FOR SUBBURAJ KALIYAMMAL (WP NUMBER: 0
36604573) : YES
NAME OF EMPLOYMENT AGENCY

: S & A CONSULTANTS PTE. LTD.

LICENCE NO.

13C6638

REGISTERED ADDRESS

: 10
#26-04 INTERNATIONAL PLAZA ANSON ROAD
SINGAPORE 079903

TELEPHONE

62955124

PART III (A) DECLARATION BY EMPLOYMENT AGENCY (applicable if the employer has used the services of an Employment Agency or
intermediary. If more than one Employment Agency/intermediary is used, please download additional declaration sheets from MOM website)
I declare that (a) I, the undersigned, am the Employment Agency personnel handling this application.
(b)

To the best of my knowledge, that the foreign domestic worker in this Application (if she is a first-time foreign domestic worker in Singapore) has
had a minimum of 8 years of formal education; and possesses the necessary educational certificate as documentary proof of such education
(applicable if the foreign domestic worker is recruited through an Employment Agency).

(c)

I have explained the contents of the application and the applicable conditions and regulatory conditions of work permit, as specified in the
Employment of Foreign Manpower (Work Passes) Regulations c.91A to the foreign employee and the employer.

(d)

The information as set out in this application and any appeals I have made in relation to this application is, to the best of my knowledge, true and
correct; and that all documents I have submitted in support of this application and any appeals I have made in relation to this application are true
copies of the authentic documents.

Name of Employment Agency Personnel:

Employment Agency Stamp:

Employment Agency Personnel Number:

Signature:

Date:

FIWPS550

(DD-MM-YYYY)

Page 3 of 3

*03660457319750518*
*03660457319750518*

Casino Self-Exclusion Application Form

For Foreigners
USE BLOCK LETTERS
Personal Particulars
Name (as in Passport)

Passport No

SUBBURAJ KALIYAMMAL

L8783589

Date of Birth (dd/mm/yyyy)

FIN No (if available)

18/05/1975

N.A.

Nationality

Gender

INDIAN

FEMALE

Contact Information (of Employer in Singapore If available)

Address
506 BUKIT BATOK STREET 52
#02-79
SINGAPORE 650506
Contact No

Email (if available)

62972123

NS.DAVID@YAHOO.COM.SG

FWPOL610

Page 1 of 2

*03660457319750518*
*03660457319750518*

Declaration for Applicant (Please Tick All Boxes)

I fully understand the content and purpose of this Casino Self-Exclusion application, and
that the effect of this application is that I will be excluded from entering the casinos in
Singapore. I further understand that this exclusion shall take effect immediately upon my
submission of this application to the National Council on Problem Gambling. I am also fully
aware that if I choose to enter or remain on the Casino premises after submitting the
application and take part in any gaming activities, any winnings paid or payable to me shall
be forfeited, and I will not be able to lay any claim to the said winnings.
I declare that this application is made voluntarily, without any force or coercion or under
any duress.
I understand that my application for Self-Exclusion will stay in force indefinitely, unless I
apply to revoke from NCPG after a period of at least 1 year. I also understand that NCPG
will provide my name and particulars to the relevant agencies and organizations under
Section 168(3) of the Casino Control Act to inform them of my Self-Exclusion.
I declare that the information provided by me in this application is true and correct and I
furnish the information knowing that I may be liable to criminal prosecution if I have stated
any information that I know to be false or do not believe to be true.

_______________
Signature

_______________
Date

PLEASE COMPLETE AND SEND THIS FORM BY HAND OR BY REGISTERED MAIL

TO:
THE NATIONAL COUNCIL ON PROBLEM GAMBLING
510 THOMSON ROAD
#05-01
SLF BUILDING
SINGAPORE 298135
For Administrative Use only
Date / Time

Signature

Received by:
Processed by:

FWPOL610

Page 2 of 2