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Applicant Details Contact Details Membership Details Acknowledgement & Consent

Applicant Details

Salutation

Name (as per NRIC)

Gender

Date Of Birth

Country of Birth

Nationality

NRIC No. (mandatory for Board Members only)

Identification Type

Religion

Marital Status

Highest Education Level

Name Of Employer

Occupation

Occupation Grouping

Language Competencies

Language Skill		Languages		Other Languages	Proficiency		Action

Experience Working With Charities
Yes No

Number of Years Experience Working With Charities

Relationship with other SHINE Staff/Member(s)
Yes No

Name of Staff/Member

Present Membership in other societies/charities
Yes No

Membership History

Name of organisation	Period/Start Date	Position Held

Contact Details

Mobile phone

Home Address - Block / Unit Number

Street

Building Name

Postal Code

Country

Preferred Method of Contact

Office No

Office Address

Preferred Correspondence Address

Membership Details

Membership Category

Subscription

Fee

Membership Information

Role held in SHINE		Committee		Date of Appointment

Acknowledgement & Consent

I am not a bankrupt nor am I undergoing any bankruptcy proceeding

I have not been convicted in a court of law in Singapore or any other country

I further give consent to SHINE Children & Youth Services to conduct the necessary background check in compliance with regulatory requirement.

I agree to receive communications on events and marketing

I acknowledge and give consent to report the information on this form to the Registry of Societies or any other regulatory bodies as requuired by law or the government of Singapore.

Please draw your signature below