FORM 14A
IMMIGRATION ACT 1959 [SECTION – 55(1)]Notes:

Affix a recent
Passport-size
photograph here

* Check the box where appropriate

APPLICATION FOR ENTRY VISAPART I – PARTICULARS OF APPLICANT
Name:(Full name as shown intravel document)

Alias:

Date of Birth:

Sex:*
D

Marital Status:*D

M M

SingleY

MarriedNationality/Citizenshipof Spouse:*

Y Y

MaleFemale

WidowedCohabitedY

Separated

Divorced

Singapore Citizen

NRIC No.

Singapore Permanent Resident

NRIC No.

Customary

Others (Please Specify):

Country/Place of Birth:State/Province of Birth:
Race: (e.g. Malay, Indian,Chinese, Caucasian, etc)

Nationality/Citizenship:

Type of Travel Document Held:*International Passport
Service Passport
Others (please specify)

Diplomatic PassportDocument of Identity

Official Passport
Certificate of Identity

Travel Document No.:
Travel Document
Issued Date:

Expiry Date:
D

D

M M

Y

Y Y

Y

Country/Place of Issue:

For Chinese Nationals Only

PRC ID Number

IMM 14A

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D

DM M

YYYY

Address in Country/Place of Origin/Residence
Country/Place of Origin/Residence:
Division/State/Provinceof Origin/Residence:
Prefecture of Origin/
Residence:
County/District of Origin/
Residence:
Address:

PART II – OTHER DETAILSEmail Address:
Contact Number:
Occupation:

Highest Academic/
Professional
Qualifications Attained:*

No Formal Education
Diploma

Primary

Secondary

University

Post-Graduate

DY

Pre-University

Annual Income inSingapore dollars (SGD):
Religion:
Expected Date of Arrival in Singapore:D
Type of Visa:*
Purpose of visit:*

M M

Single Journey

Double JourneySocialBusiness

Y YY

Triple Journey

Multiple Journey

Details of purpose:

How long do you intend to stay in Singapore:*Less than 30 days

More than 30 days

If your intended stay in Singapore is more than 30 days, please state the reason for your intended length of stay and theduration

IMM 14A

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Address in Singapore
Where will you be staying in Singapore?:*Next of Kin’s Place

Relative’s PlaceBlock/House No.:

Friend’s Place

Floor No.:

Hotel

Others (Please specify):

Unit No.:

Postal Code:Street Name:

Contact No:

Building Name:

Did you reside in other countries/places, other than your country/place of origin, for one year or more during the last 5 years ?*YesNo

If yes, please furnish details

Period of Stay

Country/Place

Address

FromToDetails of Travelling Companion(Only for applicant who is 12 years old or less at the point of application. Details are not required if applicant is accompanied by anairline representative.)
Relationship ofTravelling
Companion
To Applicant:Name:

Date of Birth:

Sex:*
MaleD

DM M

YY

Y Y

Nationality/Citizenship:
Travel Document
Number:IMM 14A

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FemalePART III – PARTICULARS OF LOCAL CONTACT
Details of Local Contact or Company/Hotel in Singapore
Name of Local Contact/Company/Hotel:

Relationship ofLocal Contact/Company/
Hotel toApplicant:Contact No.:

Email Address:

PART IV – ANTECEDENT OF APPLICANT*(a) Have you ever been refused entry into or deported from any country/place, including Singapore?

Yes

No

(b) Have you ever been convicted in a court of law in any country/place, including Singapore?

Yes

No

(c) Have you ever been prohibited from entering Singapore?

Yes

No

(d) Have you ever entered Singapore using a different passport or name?

Yes

NoIf any of the answer is “YES”, please furnish details below

PART V - DECLARATION BY APPLICANT
I declare that all information submitted in this application is true, accurate and complete to the best of my knowledge and belief. I
understand that, if I have concealed relevant information or provided false, inaccurate or misleading information, I may be prosecutedand any facilities, rights or privileges granted under this application may be withdrawn.
I undertake not to misuse controlled drugs or to take part in any political or other activities during my stay in Singapore which would
make me an undesirable or prohibited immigrant under the Immigration Act 1959.
I undertake to comply with the provisions of the Immigration Act 1959 and any regulations made thereunder or any statutory
modification or re-enactment thereof for the time being in force in Singapore.
I undertake not to involve in any criminal offences in Singapore.
I undertake not to indulge in any activities which are inconsistent with the purpose for which the immigration passes have been issued
I further undertake not to be engaged in any form of employment, business or occupation whilst in Singapore without a valid work passissued under the Employment of Foreign Manpower Act 1990.
I am aware that overstaying or working illegally in Singapore is a serious offence and on conviction, the penalties may include mandatory
imprisonment and caning.
I understand that if the Controller of Immigration is satisfied that I or any member of my family breaches this undertaking or becomes anundesirable or prohibited immigrant, he will cancel my immigration pass and the passes of the members of my family, and we may berequired to leave Singapore within 24 hours of such cancellation.
I understand that this application for and possession of a visa does not guarantee entry into Singapore and permission to entry is entirely
discretionary at the point of entry.
I give my consent for your department to obtain and verify information from or with any source as you deem appropriate for theassessment of my application for immigration facilities.

Date

IMM 14A

Signature of Applicant

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