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Remarks/Explanation (if any):

	*I have read and agreed to the declaration. ........................................ ............................................................................................ Date Signature of Applicant

IMM16
-2-
ADDITIONAL INFORMATION ON APPLICANT FOR APPLICATION FOR STUDENT'S PASS [eFORM V36]

PART A - APPLICANT'S PARENTS AND/OR STEP PARENTS
Full Name (As appears in travel document)	Relationship	Date of Birth (DD/MM/YYYY)	Nationality	Residential Status in Singapore	Occupation
TILLAEV TUYIN MAQSADOVICH	FATHER	10.01.1963	UZBEK	NO	SALES ASISTENT
BOBEVA MEHRINISO MANSUROVNA	MOTHER	01.08.1967	UZBEK	NO	HOUSEWIFE

PART B - APPLICANT'S SPOUSE
Full Name (As appears in travel document)	Relationship	Date of Birth (DD/MM/YYYY)	Nationality	Residential Status in Singapore	Occupation

PART C - APPLICANT'S NATURAL SIBLINGS
Full Name (As appears in travel document)	Relationship	Date of Birth (DD/MM/YYYY)	Nationality	Residential Status in Singapore
MAKSADOV ZAYNOBIDDIN TUYIN UGLI	BROTHER	26.03.1993	UZBEK	STUDENT
MAKSADOV MUROD TUYIN UGLI	BROTHER	26.07.1994	UZBEK	BUSINESMAN
MAKSADOV SHERZOD TUYIN UGLI	LITTLE BROTHER	20.08.2003	UZBEK	STUDENT

PART D - APPLICANT'S EDUCATIONAL BACKGROUND (INCLUDE COURSES ATTENDED IN SINGAPORE)
Name of Schools/Colleges/Universities (In Chronological Order)		Country	State or Province	Language of Instruction	Period of Study From To		Qualification (Academic/Professional) Obtained	Educational Certificate No.
SAMARKAND STATE FOREGIN LANGUAGE ACADEMIK LISIYUME		UZBEKISTAN	SAMARQAND	ENGLISH	2014	2017




Obtained a pass in English :			Yes / No
	I do not have any information to declare for the above Part D.

PART E - APPLICANT'S EMPLOYMENT HISTORY/OTHER ACTIVITIES (INCLUDE PRACTICAL TRAINING, INDUSTRIAL ATTACHMENT AND INTERNSHIP IN SINGAPORE)
Name of Companies		Country	Period of Working From To	Position Held	Nature of Duties



	I do not have any information to declare for the above Part E.
Remarks/Explanation (if any)

V36
-3-

PART F - APPLICANT'S FINANCIAL SUPPORT
Applicant	Average Monthly Income for past 6 months:	SGD	Applicant's Spouse	Average Monthly Income for past 6 months:	SGD
	Current Saving:	SGD		Current Saving:	SGD
Applicant's Father	Average Monthly Income for past 6 months:	SGD	Applicant's Mother	Average Monthly Income for past 6 months:	SGD
	Current Saving:	SGD		Current Saving:	SGD
Other financial support (eg. scholarship, study loan, funds from relatives): If yes, please furnish details (eg. amount in Singapore Dollars)

PART G - APPLICANT'S SINGAPORE CITIZEN/ PERMANENT RESIDENT PARENTS'/ STEP PARENTS' ADDITIONAL INFORMATION

Additional Information for Applicant's Parents/Step Parents

Full Name
(As appears in travel document)

Relationship

Marital Status

Marriage Certificate No.

Marriage Date

Divorce Certificate No.

Divorce Date

Custody of Applicant

Educational Details for Applicant's Parents/Step Parents

N.A.

Full Name
(As appears in travel document)

Relationship

Name of
School/College/University

Country

Highest Educational
Qualification
(Academic/Professional)

Educational Certificate No.

Employment Details for Applicant's Parents/Step Parents

N.A.

Full Name
(As appears in travel document)

Relationship

Name of Company

Monthly Income (SGD)

Annual Income for the Past 1 year
(SGD)

Average monthly CPF
contribution for the past 1
year (SGD)

PART H - APPLICANT'S SINGAPORE CITIZEN/PERMANENT RESIDENT SPOUSE'S ADDITIONAL INFORMATION
Marriage Certificate No.: Date of Marriage:
Spouse's Highest Educational Details	N.A.
Name of School/College/University	Country		Highest Educational Qualification (Academic/Professional)	Educational Certificate No.


Spouse's Current Employment Details		N.A.
Name of Company	Monthly Income (SGD)		Annual Income for the Past 1 year (SGD)	Average monthly CPF contribution for the past 1 year (SGD)

PART I - DECLARATION

I hereby declare that all the particulars and information given in this application for a Student's Pass is true and correct.

........................................ ............................................................................................
Date Name and Signature of Applicant

WARNING
IT IS AN OFFENCE UNDER THE IMMIGRATION ACT TO MAKE ANY FALSE STATEMENT, REPRESENTATION OR DECLARATION IN CONNECTION
WITH THIS APPLICATION

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