Oscar George da Silva University Scholarship

*Use one form per applicant. Please complete all relevant sections. All entries are to be done in BLOCK letters. (* Tick appropriate box)

By completing and submitting this form, you consent to the Eurasian Association’s (EA) collection, use and disclosure of your personal data for the purposes of processing and administering this membership. Your personal data may be disclosed to EA’s employees, membership sub-committees, volunteers and third parties for the purpose of providing the relevant membership services to you. For more information, please refer to EA's Privacy Policy
Please do not attach your NRIC for Personal Data Protection

APPLICANT’S PERSONAL PARTICULARS

Salutations

First Name

Surname

House / Block No.

Resident Address / Street Name / Development Name (As per NRIC) *

Floor No.

Unit No.

Postal Code

Sex

Date of Birth

Home No.

Mobile No.

NRIC No. (First & Last 4 characters)

Race Race

*Definition of Eurasian:
- Who is of both European and Asian ancestry; or
- Whose family has been accepted as Eurasian by custom and tradition

Occupation

Marital Status Marital Status

Spouse’s Name

Contribute in Some Other Way

MEMBERSHIP CATEGORY

Membership List

Life Membership ($60)

Ordinary Member ($12 p.a)

Eurasian Singaporeans & Permanent Residents Only

Associate Life ($60)

Associate Ordinary ($12 p.a)

Associate International ($60)

Eurasians who are neither Singaporean nor PR who may or may not be resident in Singapore, may apply for Associate International Membership

Junior (<18 Years Old) (Waived)

EA Staff will be in contact with you to verify your NRIC

EURASIAN COMMUNITY FUND CPF – MONTHLY CONTRIBUTION

Yes / No

Yes

No. of Years (Contribution to ECF) *

Years

File Upload (ECF contribution prove or past 3 months payslip or any other supporting documents other than NRIC)
Please remove salary amount and leave your contribution amount for verification *

Maximum file size: 20MB

File format supported - pdf, doc, png, jpeg, bmp

FOR ASSOCIATE LIFE & ORDINARY APPLICATIONS ONLY

Reason for Application / Name of Introducer (If any)

FOR JUNIOR APPLICATIONS ONLY

Name of Parent/s

Father

Mother

Applicant’s School / Institution

Level

Year

PAYMENT

Payment Type

Cash

Cheque

Bank Transfer

Amount payable

Bank / Cheque No

To make payment by cash, please head down to our office at:
139 Ceylon Rd, Singapore 429744
Tel +65 6447 1578

To make payment by cheque:
Please make your cheque payable to ‘The Eurasian Association’

Address:
139 Ceylon Rd, Singapore 429744

I,hereby confirm that I understand and agree to all provisions in this form.

Applicant’s Signature

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Oscar George da Silva University Scholarship

Name of Parent/s

Parent's Membership Category

Applicant’s School / Institution

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