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S Pass No
: 0 25725956/23/05/2011
Work Pass Division
Our Ref
: G5107793N/G7/SYSTEM
Ministry of Manpower
Date
: 22/02/2011
18 Havelock Road Singapore 059764
Employment Pass Online Application
Telephone
: (65) 64385122
Facsimile
: (65) 62932138
Website
: http://www.mom.gov.sg
Email
:
[email protected]
*02572595622022011* SALVO PTE. LTD. 100 BEACH ROAD #32-07 SINGAPORE 189702
Dear Sir/Madam
IN-PRINCIPLE APPROVAL LETTER FOR S PASS
Name of Employer
: SALVO PTE. LTD.
UEN - Div - Br
: 200509318G-00-000
CPF Submission No.
: 200509318G-PTE-01
S Pass Holder's Particulars: Name
: CHRISTINA GO RIVERA
FIN
: G5107793N
Date of Birth
: 19/11/1959
Date of Application
: 22/02/2011
Gender
: FEMALE
Period Granted(months)
: 12
Nationality
: FILIPINO
Pass Category
: S
Travel Doc. No./Expiry Date
: TT0114344/17/05/2011
Occupation
: SALES EXECUTIVE
Medical Examination
: HIV Test and Chest X-Ray Test
Application No.
: A220211378741
We are pleased to inform you that this application has been given an in-principle approval, which is valid until 23/05/2011. Please be informed that this In Principle Approval letter does not allow the pass holder to commence work until his/her S Pass has been actually issued. As this letter does not validate the stay of the pass holder in Singapore, he/she should submit a request for the issuance of the S Pass card as soon as possible.
Please note that this approval does not exempt the pass holder from registration or compliance with any other conditions required under the respective professions, for which professional registration to practise in Singapore is a prerequisite (e.g. medicine, dentistry, pharmacy, architecture, law, etc).
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Our Ref : G5107793N/G7/SYSTEM
Online Request for Issuance of S Pass Employers may apply for the issuance of the S Pass electronically, via Employment Pass Online (EPOL). The issuance procedures are detailed in the "Procedures and Documents Required For Collection of S Pass".
Medical Examination The pass holder is required to undergo a medical examination, including the HIV blood test and/or chest x-ray examination, as indicated under Medical Examination on the cover page of this letter. The medical examination report, HIV blood test and/or chest x-ray reporting (in English) must be done not earlier than 3 months before the pass collection date. Please refer to our website at http://www.mom.gov.sg for further important information and instructions for the medical examination.
If the pass holder needs an extension of his/her Short Term Visit Pass pending the outcome of the medical examination, please submit your request via fax (Fax No: 63171359) to the Work Pass Division. A copy of the doctor's confirmation indicating that the medical report is not ready has to be faxed over.
E-Payment of Salaries for S Pass holder Employers are required to arrange for their S Pass holders to start receiving salaries electronically through General Interbank Recurring Order (GIRO), Internet Funds transfer, ATM Funds transfer, Standing Order or Funds Transfer through bank counters within 3 months of the issuance of their S Pass. Employers in the following situations are exempted from electronic payment of salaries for their S Pass holders:
The S Pass is issued for a period of 3 months or less; Wages due to the S Pass Holder for his/her last month of employment with the employer; or Wages for overtime work done by the S Pass Holder.
The employer is required to maintain records of the salary payment paid to the S Pass holder. Employers who failed to comply with this condition may be fined or prosecuted. MOM may also take this into account in assessing the employer's future work pass applications.
Local Residential Address According to our records, the local residential address of the pass holder is as follows:
SINGAPORE
If there are changes to the address, you are required to update the new address via EPOL during issuance. If you do not have an EPOL account, you are required to indicate the new address below and then present this letter to the Work Pass counters when you collect the Notification Letter.
New residential address Block/House No.
:
Street Name
:
Floor/Unit No.
:#
Building Name
:
Postal Code
-
:
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Our Ref : G5107793N/G7/SYSTEM
Foreign Worker Levy The employer is required to pay a levy of S$110 per month from the commencement date of this S Pass. If he/she is employed for part of a month, the levy is payable at the rate of S$3.62 a day.
Payment of Levy via GIRO The employer is required to pay monthly foreign workers' levy by General Interbank Recurring Order (GIRO). Failing to comply may affect the employer's future application and renewal of Work Permit and S Pass.
Medical Insurance An employer is responsible for and shall bear the cost of the S Pass Holder's medical treatment. The employer shall purchase and maintain medical insurance for each S Pass Holder'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 SGD$15,000 per year (or for such shorter period where the S Pass holder's period of employment is less than twelve months). You have to provide the company's insurance details through one of the following options:
The "Medical Insurance Function" in WPOnline During Issuance of S Pass in EPOL Furnishing a hardcopy of the Medical Insurance if issuance is done at counter (only if company does not have a WPOL account)
Yours faithfully,
Controller of Work Passes (As this is a computer generated letter, no signature is required)
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Our Ref : G5107793N/G7/SYSTEM
Procedures And Documents Required For Collection Of S Pass FIN: G5107793N Name of S Pass Holder: CHRISTINA GO RIVERA Name of Employer/Sponsor: SALVO PTE. LTD.
You can apply for issuance of the Pass using your EPOL account and SINGPASS (known as Singapore Personal Access required for transactions involving the Government's eServices). For more information on EPOL registration and SINGPASS application, please visit "Services & Forms" at the MOM's website at http://www.mom.gov.sg and the eCitizen's website at http://www.eCitizen.gov.sg respectively. Alternatively, you can approach a licensed Employment Agency to carry out this transaction on your behalf.
After you have applied for pass issuance, the following documents must be produced for verification at the Work Pass Services Centre (WPSC). Failure to do so may result in the revocation of the work pass. For non-English certificates / documents submitted, we would require them to be translated into English by certified translators. MOM reserves the right to request the submission of any other documents, including their originals, even after the collection of the pass:
This In-Principle Approval letter The pass holder's original passport / travel document, which must have a remaining validity of at least 7 months (Where the validity is less
than or equal to the period granted for your S pass, please note that the S pass will only be issued up to 1 month before the expiry date of your passport / travel document) The completed medical examination form The original and completed Declaration Form duly signed by the pass holder, local Employer/Sponsor and if applicable, the Third Party user who submitted the application on behalf of the local employer/sponsor 1 clear photocopy of each of the Education Certificate (with official English translation) as shown in the Declaration Form. The pass holder is required to endorse his/her signature in person on the education certificate confirming ownership and authenticity, in the presence of the counter officer at the Employment Pass Services Centre (EPSC) / Work Pass Services Centre (WPSC) Foreigners who are currently holding an Employment Pass, S Pass or Training Employment Pass and/or related pass(es) (Dependant's or Long Term Visit Pass) and wish to change employer or pass type, are required to get their employer/ to cancel their current work pass and/or related pass(es) via EP Online before they can proceed with issuance of their Pass For change of employer, Pass holder who is currently holding a Work Permit has to ensure that the Work Permit is cancelled via WP Online before he/she can collect his/her Employment/ S Pass
Please note that the Dependant's Pass and Long Term Visit Pass cannot be issued before the Employment/S Pass holder's pass has been issued.
Fees payable for the Issuance of the pass(es) The Work Pass Division (WPD) will only accept payment via credit card (Master and Visa), eNets Debit or Giro (if your company has signed up as a Giro user) for issuance done via EPOL. The amount of fees payable are as follows:
S$30 per year or part thereof for a S Pass/Dependant's Pass S$30 per issue of a Multiple Journey Visa (if applicable) S$30 per issue of a Single Journey Visa (if applicable)
Note that you are also required to pay the fees for the issuance of S Pass when submitting your issuance request via EPOL. Fees payable are stated above.
Registration At Work Pass Services Centre (WPSC) To issue the pass holder with a secure Card containing biometric data for personal identification, he/she may be required to visit the WPSC. Print the Notification for Registration Letter via EPOL
The Notification Letter will state whether the pass holder is required to visit the WPSC for fingerprinting and the documents needed for verification;
If this pass holder is required to report to the WPSC, he/she has to do so in person at Tanjong Pagar Complex, 7 Keppel Road, #0227/29,Singapore 089053 within 7 calendar days of the date of the Notification Letter. The secure Card will be ready for collection at the WPSC 4 working days later.
If this pass holder is not required to report to WPSC for photo imaging and fingerprinting, the secure Card can be collected from the WPSC 4 working days after the Notification Letter is issued.
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MINISTRY OF MANPOWER, WORK PASS DIVISION MEDICAL EXAMINATION FORM
1. This form is to be completed by a qualified doctor and returned to the examinee. 2. The examinee must produce his/her passport and the In-Principle Approval letter from the Work Pass Division, Ministry of Manpower, Singapore to the Examining Doctor. 3. This medical report, along with the chest x-ray and HIV test reports, must be submitted by the examinee to the Work Pass Division, Ministry of Manpower, Singapore, at the time of collection of pass.
I Personal Particulars Name (as in the passport): Sex: (M / F)
Date of Birth:
Nationality:
Passport No.:
FIN No.:
II Clinical Examination Normal
Abnormal
No
Yes
Remarks
1. Cardiovascular System 2. Respiratory System 3. Abdomen 4. Neurogical
III Other Tests 1. Chest X-ray* - Any evidence of active TB detected? NOTE: One of these boxes must be ticked, otherwise, the report will not be accepted. [* Pregnant women are exempted from Chest X-ray. Please tick box below if examinee is pregnant] Examinee is pregnant Negative/Non-Reactive
Positive/Reactive
2. HIV(AIDS) NOTE: The name in the HIV Report must be according to the name shown in the Passport. IV Certification I certify that I have examined the above-named person and my findings are as above. Fit I also certify that he/she is
Unfit for employment (basing on findings under Clinical Examination)
Name of Examining Doctor (IN BLOCK LETTERS): Signature:
Date:
Clinic's Stamp & Address: Telephone Number: Note: The pass will not be issued if the examinee fails the medical examination and the in-principle approval will be deemed as withdrawn. If he/she is in Singapore, he/she must leave before the Short Term Visit Pass expires.
WARNING: IT IS AN OFFENCE UNDER THE EMPLOYMENT OF FOREIGN MANPOWER ACT AND THE IMMIGRATION ACT TO MAKE ANY FALSE STATEMENT, REPRESENTATION OR DECLARATION
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DECLARATION FORM FOR AN APPLICATION FOR AN S PASS 1. This Declaration Form is to be completed and signed only after the In-Principle Approval (IPA) letter has been issued. 2. If there are any discrepancies found in the information found in this Declaration Form, the correct information must be provided in writing to the Work Pass Division, Ministry of Manpower via the iSubmit web portal on the MOM website (http://www.mom.gov.sg/isubmit), before the collection of the Pass. If there has been a change in the information, the application will need to be re-assessed. If the Pass Holder is still in his/her home country, the Pass Holder is advised not to enter Singapore till the application is re-assessed and approved. 3. The original copy of the completed Declaration Form must be submitted to the Work Pass Services Centre (WPSC), Ministry of Manpower, Singapore, when the S Pass is collected (if pass is issued via EPOL).
*G5107793N22022011* PART A DECLARATION BY PASS HOLDER Our Reference: G5107793N/22/02/2011/22/02/2011/S
I, CHRISTINA GO RIVERA, reference no: G5107793N/A220211378741, declare that the following particulars provided in my Application for a/an S Pass Form are true and correct:-
i. Date of Application: 22/02/2011 ii. Date of Birth: 19/11/1959 iii. Nationality: FILIPINO
iv. Educational details: Country of Awarding Body/Institution/University: PHILIPPINES Name of Awarding Body/Institution/University: PHILIPPINE WOMEN'S UNIVERSITY Main Campus or Affiliating College Attended: Qualification : BACHELOR'S DEGREE Faculty: SCIENCE Mode of study: FULL-TIME Period of study : from 07/06/1977 to 31/03/1981
v. Name of Employer/Sponsor: SALVO PTE. LTD. vi. Occupation under S Pass: SALES EXECUTIVE vii. Fixed Monthly Salary under S Pass (S$): 1,800 viii. Basic Monthly Salary under S Pass (S$): 1,800
I declare that: i. I have never been refused entry or deported from any country. ii. I have never been convicted in a court of law in any country. iii. I have never been prohibited from entering Singapore. iv. I have never entered Singapore using a different passport issued by a different country. v. I have never entered Singapore using a different name. vi. I have never been a citizen or permanent resident of Singapore. Declaration Details: -
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Our Ref : G5107793N/G7/SYSTEM
Employment 1 I shall work only for the employer and in the occupation specified in the S Pass/Visit Pass. 2 I shall not engage in or participate in any business or be a self-employed person. 3 I shall reside at the address stipulated by my employer upon the commencement of my employment. I will inform my employer about any change in residential address initiated by me. 4 I shall undergo a medical examination by a Singapore registered doctor as and when directed by the Controller. I understand that if I am certified medically unfit, my S Pass shall be revoked. 5 I shall carry my original S Pass/Visit Pass with me at all times and must produce it for inspection on demand by any public officer. 6 I shall report to the Controller as and when I am required by the Controller to do so.
Further and in addition, I hereby declare that 1 I shall not make any false statement or submit any document which I know to be false in order to obtain an S Pass or Visit pass. 2 I understand that if I breach any condition above, my S Pass/Visit pass will be revoked and I can be prosecuted in court, or expelled and prohibited from entering Singapore. 3 I shall not misuse controlled drugs or 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 have read and understood the Conditions of S Pass/Visit Pass For Foreign Worker, as specified in the Sixth Schedule of the Conditions of Work Permits / S Passes, Employment of Foreign Manpower Act, which is available on the MOM website. I shall abide by these conditions during my employment and stay in Singapore.
I confirm that the information as set out in the Application for an S Pass Form and this Part is, to the best of my knowledge, true and correct. All documents submitted with this Declaration Form and in support of my Application for an S Pass are true copies of the originals. I understand that I may be prosecuted if I have provided any information which is false in any material particular, or is misleading by reason of the omission of a material particular.
With reference to this application submitted for S 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.
I hereby give my consent for the Comptroller of Income Tax to verify my income stated in my current and renewal applications, based on my assessment record for the current Year of Assessment, for the Controller of Work Passes. In the event my assessment record for the current Year of Assessment is not available or finalized at the point of verification, I understand the Comptroller of Income Tax will verify my income against my assessment record for the two previous Years of Assessment. I also hereby give my consent for the Comptroller of Income Tax to thereafter communicate the results of the verification to the Controller of Work Passes.
_________________________________
_________________________________
(Signature of Pass Holder)
(Date of Signature)
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Our Ref : G5107793N/G7/SYSTEM
PART B DECLARATION BY LOCAL EMPLOYER/SPONSOR Our reference: G5107793N/22/02/2011/22/02/2011/S
Employment 1 The S Pass Holder shall be under my direct employment, and I shall be responsible for the control and supervision of my S Pass Holder. I shall not permit my S Pass Holder to be employed by or contracted to any other person or business. I shall not employ my S Pass Holder in an occupation which is different from that specified in the S Pass. Upkeep, Maintenance and Well-being 2 I shall pay my S Pass Holder his/her salary due to him/her for the month not later than seven (7) days after the last day of that month. I shall maintain a record of the monthly wages paid to my S Pass Holder and produce the record upon request by any public officer. The wages shall be paid through General Interbank Recurring Order (GIRO) or other electronic means as may be approved by the Controller in writing, except where: (a) the S Pass is issued for a period of 3 months or less; (b) the wages represent the wages due to the S Pass Holder for his/her last month of employment with the employer; (c) the wages represent wages for overtime work done by the S Pass Holder; or (d) the Controller, in his discretion, exempts I, as the employer, in writing from this condition. 3 I shall send my S Pass Holder for a medical examination by a registered Singapore doctor as and when directed by the Controller. I shall also bear any medical expenses incurred by my S Pass Holder for the medical examination. 4 I shall be responsible for and bear the costs of the S Pass Holder's medical treatment. I shall purchase and maintain medical insurance for each S Pass Holder'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 SGD$15,000 per year (or for such shorter period where the S Pass holder's period of employment is less than twelve months). 5 I shall be responsible for the upkeep and maintenance of the S Pass Holder.
Cancellation of S Pass / Visit Pass and Duties before/ upon Repatriation of the S Pass Holder 6 I shall cancel the S Pass / Visit Pass of the S Pass holder if I do not require his/her services or do not wish to renew his/her S Pass / Visit Pass. I shall inform the Controller in writing within seven (7) days of such cessation or termination and return the S Pass / Visit Pass to the Controller. I shall be responsible for his/her repatriation unless he/she is transferred to another employer. 7 I shall indemnify the Singapore Government for any charges or expenses which may be incurred by the Government in respect of the repatriation of the said S Pass holder or any of his/her dependants. 8 If the S Pass / Visit Pass of the S Pass Holder has expired or is cancelled or revoked, I shall ensure that all outstanding salaries or monies due to the S Pass holder have been paid before his/her repatriation.
General 9 I shall provide information, documents and statements, which are true and correct, as and when required by the Controller. 10 I shall not retain the original S Pass / visit pass and I shall allow my S Pass Holder to retain his/her S Pass / visit pass. 11 I shall produce my S Pass Holder to the Controller as and when I am required by the Controller to do so. 12 I shall inform the Work Pass Division of any change to my company's address stated in this Application Form within fourteen (14) days of such a change. 13 If my S Pass Holder goes missing, I shall inform the Ministry of Manpower (MOM) within seven (7) days of my knowledge. 14 I shall undertake to make arrangements for payment of my foreign workers'levy by General Interbank Recurring Order (GIRO) and to pay the levy through GIRO deduction each month. 15 I am aware that my company / firm's Central Provident Fund account(s) are used by the Controller of Work Passes for the purpose of determining my local workforce and foreign worker entitlement, and I certify that the account(s) only include Central Provident Fund contributions made to persons actively employed by my company / firm. 16 I have/have not* used the services of an Employment Agency or intermediary based in Singapore for the recruitment of the foreign worker. (Please also state the licence number of all Employment Agencies or intermediaries (if any) used for the purposes of this application: ___________________________________. Please ensure that a copy of Part C of this form is completed by each Employment Agency or intermediary used.) 17 I have not been offered or received (directly or indirectly), any sum or other benefit: (a) as consideration or as a condition for employing the foreign employee; (b) as consideration or as a condition for continuing to employ the foreign employee; or (c) as a financial guarantee related, in any way, to the employment of the foreign employee.
I, (Name of authorised representative) ____________________________________________ (NRIC No./FIN No.) _________________ in my capacity as (Designation in company/firm) ________________________________ of (Name of company/firm) SALVO PTE. LTD. declare that I have read and understood the above.
I also declare that the following details are true and accurate:-
i. Occupation under S Pass: SALES EXECUTIVE ii. Fixed Monthly Salary to be paid to Pass Holder (S$) : 1,800 iii. Basic Monthly Salary to be paid to Pass Holder (S$) : 1,800
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* Delete where inapplicable.
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Our Ref : G5107793N/G7/SYSTEM
I further declare that Part A of this Declaration Form was, to the best of my knowledge, personally completed and signed by the Pass Holder whose name is indicated in the In-Principle Approval letter. I have ensured that the Pass Holder fully understands the contents of Part A of the Declaration Form. I confirm that the information as set out in the Application for an S Pass Form and this Part 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 is misleading by reason of the omission of a material particular. I further understand that any false statement made by my company or myself in relation to the Application for an S Pass Form or this Declaration Form may adversely affect the future work pass applications of my company/firm. I shall keep copies of the Pass Holder's education certificates as declared in the application form for as long as the Pass Holder is in my employment. I 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. I further undertake that in consideration of the issue to the Pass Holder of an S Pass, I shall on demand forthwith pay to the AccountantGeneral any charges or expenses which may be incurred by the Government in respect of the repatriation of the said Pass Holder or any of his/her dependants. I further confirm that I have read and understood the Conditions of the S Pass/Visit Pass for Employer and Foreign Worker as specified in the Fifth Schedule and Sixth Schedule, respectively, of the Conditions of Work Permits / S Passes, Employment of Foreign Manpower Act, which is available on the MOM website. I shall ensure that these conditions will be complied with.
_________________________________
_________________________________
(Signature of Authorised Representative)
(Company/Firm Stamp)
_________________________________ (Date of Signature)
Note: Controller mentioned in the above declaration means the Controller of Work Passes.
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Our Ref : G5107793N/G7/SYSTEM
PART C: 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 THE ADDITIONAL DECLARATION FORM FROM MOM'S WEBSITE http://www.mom.gov.sg) Our reference: G5107793N/22/02/2011/22/02/2011/S
Name of Employment Agency/Intermediary :
_________________________________
Licence Number(for Employment Agency only) : _________________________________ Registered Address :
_________________________________
I (Name of authorized representative) _________________________________________________ (NRIC No/FIN)_____________________in my capacity as (Designation in company/firm) ____________________________ of (Name of company / firm) ______________________________ declare that the above named employer has not been offered (directly or indirectly), any sum or other benefit:
(a) as consideration or as inducement for employing the foreign employee; (b) as consideration or as inducement for continuing to employ the foreign employee; or (c) as a financial guarantee related, in any way, to the employment of the foreign employee.
_________________________________
_________________________________
(Signature of Authorised Representative)
(Company/Firm Stamp)
_________________________________ (Date of Signature)
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