PART I - PARTICULARS

TITLE:                           MR   MRS  MDM   MS   DR   PROF

NAME (IN FULL):        

NRIC NUMBER:          

DATE OF BIRTH:        

GENDER:                       MALE  FEMALE

MARITAL STATUS:   SINGLE  MARRIED  DIVORCED  WIDOWED

RACE:                                  Qualification: 

ADDRESS:                     

EMPLOYER:                  

OCCUPATION:             

TEL (H):                          

TEL (O):                          

FAX:                                

HP/PAGER:                                    HP    PAGER

EMAIL ADDRESS:       

MEMBERSHIP ORGANISATIONS / AFFILIATIONS:

OTHER COMMENTS:

PART II - DECLARATION
I, the undersigned, hereby agree to abide by the constitution and bylaws of Singapore People's Party. I confirm that I am a Singapore citizen and I am 18 years of age or older.
I have also not been convicted in a Singapore court of law and fined at least S$2,000 and / or imprisoned for more than 3 months in the 5 years preceding this application.

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