Exam Application Form

EXAMINATION APPLICATION FORM

Kindly fax completed form to FOR CFE Use ONLY.

Immediate Officer Name : ____________________________________________ Account No. _________________

Registered online : ˆ Date : ___________________

Immediate Officer Email : ________________________________________________________________________ Agency Group

6327 3088

Payment : ˆ Cash ˆ Cheque Amt : S$ __________

: __________________________________________________ Box : ________________________

Bank _______________ Cheque No. _____________

Introducing Officer Name : ________________________________(LPR/ELP/SELP) Account No. ____________

Amount to be debit : __________________________

Introducing Officer Email : _____________________________________________ Hp No. __________________

Debit Listing Prepared on : ____________________

GE CHANGI

Please indicate your office location :

GE HOUSE (Beach Road)

SECTION A : ENGLISH MEDIUM EXAMINATIONS (Module 5/Module 9/Health Insurance). Pls fill up accordingly. Examination Module :

First Attempt ($107) or

Re-enrolment ($85.60)

Preferred Date(s)

Preferred Time Slot (s)

Choice 1 Choice 2 Choice 3

SECTION B : BASIC COMPETENCY & CHINESE MEDIUM EXAMINATIONS (CMFAS M5/M8/M9/HI). Pls tick accordingly Basic Competency Examination BCE (Eng) & (Maths) BCE (Eng) BCE (Maths)

2.00pm to 4.45pm 2.00pm to 3.30pm 3.45pm to 4.45pm

1st

2nd

$85.60 -

$48.15 $48.15

1st

Chinese Medium Examination HI Chinese M5 Chinese M8 Chinese M9 Chinese

3.55pm to 5.10pm 9.00am to 11.00am 3.55pm to 5.10pm 9.00am to 11.30am

$67.40 $90.95 $90.95 $90.95

2nd $56.70 $85.60 $85.60 $85.60

SECTION C : MODULE 8 & HEALTH INSURANCE EXAMINATION (On Request Basis ONLY ). Pls tick accordingly. For MODULE 8 Exam

: † 1st Attempt : $107 † 2nd / Subsequent : $85.60 (Computer Screen)

Preferred Date of Exam : _____________________________________(Choice 1)

______________________________ (Choice 2)

For HEALTH INSURANCE Exam : † 1st Attempt : $83.50 † 2nd / Subsequent : $56.70 (Computer Screen) Preferred Date of Exam : _____________________________________(Choice 1)

______________________________ (Choice 2)

SECTION D : PERSONAL DETAILS 1. NRIC No. / Passport No.:

-

-

(Proceeding alphabet, if any must be indicated.) (Use PR No. for Singapore PR)

Nationality † Singaporean † Permanent Resident (PR) Others : ____________________ (Please specify)

2. Mr / Mrs / Mdm / Ms * Full Name : _________________________________________________________________________________________ (as per NRIC or Passport) (Underline Surname) 3. Gender :

Male

4. Age:

24 yrs & below

Female

25 – 30 yrs

Date of Birth:_________________________________________________

31 – 40 yrs

41 yrs & above

5. Home Address : _________________________________________________________________________________ Postal Code ( (Please use the same permanent address for all SCI Exams)

)

6. Tel Nos. Home : ____________________ Handphone : ___________________ Office : __________________ Fax No: ________________ **Email Address: _________________________________________________@___________________________________________________ (For Applicant(s) without Email Address, Examination confirmation will be sent to Immediate Officer by default) 7. Please indicate highest educational level attained GCE 'O' Level

GCE ‘A’ Level

Diploma

Degree

Other Qualification ______________________

SECTION E : IMMEDIATE OFFICER DETAILS (COMPULSORY). Please fill up fully, to avoid delays in processing. Declaration by Immediate Officer I, ___________________________________________________ (Immediate Officer’s Name), Account No. _____________________________ being the Immediate Officer of ______________________________________________________ (Candidate’s name) hereby authorise Great Eastern Life to debit S$ __________________________________from the above stated Commission Account being payment of examinations fees for the above stated.

__________________________________ Name & Signature of immediate Officer

_____________________ Date

DECLARATION I declare that the information given to me in this application is true and correct. I understand that misrepresentation or omission is sufficient grounds for rejecting my application. No Cancellation, Withdrawal or Replacement with be allowed and no fees refund will be made after

Registration.

Signature of Applicant

__________________ Date

NOTES:

1.

No Examination Entry Slip will be sent to you. Please check the status of your examination application(s) 2 working days before the examination date via SCI website at www.scicollege.org.sg under Registration Confirmation. For successful application(s), you will be notified of the examination confirmation and details.

2.

Please keep a copy of this application form for your own record. Kindly check that the information you have provided in this application is correct and accurate before submitting. Incorrect or inaccurate information may affect the examination processing and your examination sitting.

3.

CFE conducts regular Tutorial and Clinic sessions to facilitate learning. Kindly refer to your Immediate Officer for details of Training Schedule. You may also access www.cfe-campus.com.sg for mock exam questions and answers. Kindly approach your Introducing Officer/ Immediate Officer for password application.

4.

Examinations are conducted at the Singapore College of Insurance, 9 Temasek Boulevard, #14-01/02/03, Suntec Tower 2 Singapore 038989

5.

For clarifications, pls contact our Counter Personnel – Ms Karen Lee @ 6248 2219 or email to [email protected]. Thank You.

GST Reg No : M2-0129273-5