To: The Singapore Association of The Institute of Chartered Secretaries and Administrators (SAICSA)

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1 The Singapore Association of The Institute of Chartered Secretaries and Administrators Rochor Road, # Fu Lu Shou Complex, Singapore *APPLICATION FOR ( ) NEW STUDENT REGISTRATION ( ) RE-REGISTRATION AS A STUDENT * Please tick where applicable AFFIX A RECENT PASSPORT SIZE PHOTOGRAPH HERE To: The Singapore Association of The Institute of Chartered Secretaries and Administrators (SAICSA) I submit my registration as a student of SAICSA and undertake to comply with the regulations relating to students of SAICSA. I confirm that the information given here is to the best of my knowledge accurate in all respect. Name (In block letters) Have you previously registered as a student of SAICSA? Yes _ No _ If YES, please give details below: First registration date: Student registration No. To Be Completed By Referee I hereby recommend the abovenamed for registration as a student of SAICSA. In my opinion, the applicant is a fit and proper person for admission to pursue the SAICSA Qualification. I have known him/her for years. Name (In block letters) Designation: Telephone: (Office) Organisation: (The signatory should preferably be a member of SAICSA, or the Company Secretary of the applicant s company, immediate supervisor of applicant s department, or the head of school/department of a recognised tertiary institution.) For Office Use Only Subjects Registered/Intake: Subject (s) Exempted: Date of registration: D D M M Y Y New registration Student registration no.: Re-registration Checklist: Enclosed recent passport-sized photograph Enclosed relevant fee payment with course fee Completed all relevant sections of the application Enclosed GIRO Application form Enclosed certified copies of educational certificates and transcripts

2 Please complete ALL SECTIONS in BLOCK CAPITALS: PERSONAL PARTICULARS Name(as in NRIC/Permit): [ Mr/ Miss] Please Underline Surname Home Address: Mobile: Home Office (Personal) (Office) NRIC No: Nationality: Fin No: Date of Expiry: Country of Origin: (Singapore PR/Permit Holders) Date of Birth: Age: Gender: Marital Status: CURRENT EMPLOYMENT Job Title: Working Experience: Organisation: Date of Commencement: Address: Tel: (O) Fax: (O) Nature of Business: PREVIOUS EMPLOYMENT Job Title: From to Organisation: Address: Tel: (O) Nature of Business: Please tick the appropriate box to indicate your employing organisation:- Public Listed Company Professional Firm Private Limited Company Law Civil Service Accountancy Statutory Board, please specify: Corporate Secretarial Education Management Consultancy Financial Institution Insurance Others (Please specify): Please indicate main area of activity of your current job: Accounting Human Resource Banking Insurance Corporate Planning Internal Audit Corporate Secretarial Practice / Corporate Governance Property Administration Education Share Registration Financial Management Others (Please specify):

3 Education (Certified true copies of relevant educational qualifications must be submitted) Professional Qualification Awarding Body Full-time or Completion Date of Admission to Membership University Master / Bachelor Degree Awarded Full-time or Graduation Local Polytechnic /Other Diploma Awarded Full-time or Graduation EXEMPTION (Complete this section if you are eligible for exemption) Please tick the subject(s) from which you wish to claim exemption Professional Part I Corporate Law Financial Accounting Singapore Taxation Strategic and Operations Management Note: Application for exemption must be supported by acceptable documentary evidence of the award of the diploma, certificate or other qualification, as the case may be, and where necessary of the grade of standard attained. The onus is on the applicant to substantiate the claim for exemption and failure to provide the required information may involve in considerable delay in processing the exemption application. Only one relevant educational qualification will be considered for exemption application.

4 New Admission Criteria (Complete this section if applicable) 1. With effect of 1 st July 2008, applicants who have one of the following qualifications: Master in Business Administration (MBA); Accountancy Degree from a recognised University ; Member in one of the following Professional Accountancy Bodies: ACCA (Association of Chartered Certified Accountants) CIMA (Chartered Institute of Management Accountants) CIPFA (Chartered Institute of Public Finance Accountants) ICAEW (Institute of Chartered Accountants England & Wales) ICAI (Institute of Chartered Accountants Ireland) ICAS (Institute of Chartered Accountants Scotland) Certified Practising Accountant Australia (CPA Australia) Certified Practising Accountant Singapore (CPA Singapore) will have an option of Route 1 or Route 2 to complete the examination requirements of the SAICSA International Qualifying Scheme. 2. Only one relevant educational qualification will be considered for either route. 3. No changes of the routes of entry to SAICSA International Qualifying Scheme will be allowed after the registration. 4. Students who register the entry point under Route 2 will have to pass the Corporate Law subject in SAICSA Professional Programme Part I before proceeding to SAICSA Professional Programme Part II. Route 1 Route 2 SAICSA IQS Professional II Corporate Administration Corporate Financial Management Corporate Governance Corporate Secretaryship SAICSA IQS Professional Programme I Corporate Law SAICSA IQS Professional Programme II Corporate Administration Corporate Governance Corporate Secretaryship 1 year to complete based on two examination papers in each examination diet 1.5 years to complete based on two examination papers in each examination diet Applicable for those who are given the option of Route 1 and Route 2 I decide to register Route for SAICSA International Qualifying Scheme. I fully understand that I am not allowed to make any changes of the route after the registration. Name

5 PERSONAL DATA PROTECTION ACT CONSENT FORM 1. SAICSA provides information, updates pertaining to students on a regular basis and this includes updates on studentship, examination and activities. 2. SAICSA respects your privacy and assures that your personal data will be kept securely according to The Personal Data Protection Act ( PDPA ) 3. In compliance with the Personal Data Protection Act ( PDPA ) we seek your consent to collect and use your personal data (i.e. Name, NRIC, Contact Numbers, Mailing and addresses) for the purpose of maintaining your particulars on our databases, provisions of updates to you and to disclose such personal data to SAICSA s affiliated organisations where necessary. 4. Please indicate your consent and agreement that your personal data be used as explained above by ticking the following boxes: Studentship and Examination Updates - Yes No Activities - Yes No Mode of Communications: Via: Phone Call Sms Paper Mailers All Modes 5. SAICSA is not obligated to update you on any of the above should your preferences be NO. 6. I hereby give my acknowledgement and consent to SAICSA to use my personal data for the aforesaid purposes and services. In the event that I have registered my Singapore telephone numbers(s) with the Do Not Call Registry and wish to withhold or withdraw my consent to SAICSA in respect of receiving telephone calls and /or SMSs, I endeavour to provide sufficient notice to SAICSA of such as soon as reasonably practicable. I further agree to indemnify SAICSA against any financial penalties imposed by the Personal Data Protection Commission or any court of law in Singapore as a direct or indirect result of my failure to inform SAICSA of my registration with the Do Not Call Registry.. 7. In the event that you wish to unsubscribe this service please send an to students@saicsa.org.sg. Signature: Date: Name: NRIC No:

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