[SIPG-FORM-006] SIPG Registration Form_Individual v2https://www.spgroup.com.sg/dam/jcr:c68c9cf8-4f32-4db9-b786-9203a8c1d1ff/SIPG%20Registration%20Form_Individual_v2.docxSINGAPORE INSTITUTE OF POWER AND GAS REGISTRATION FORM (INDIVIDUAL) PART A: COURSE DETAILS Course Title Course Title Course Code Course Code Course Date Course Date Full Course Fee S$ Course Fee NOTE: # Required for SSG Funding " Required for Professional Development Point (PDU) Ä For Security Clearance to Substations D Full NRIC is Required for SSG Funding · Required to Access Learning Management System PART B: PERSONAL PARTICULARS #D NRIC/FIN Number: (Last 4 Characters eg.468A) Last 4 characters of ID or Full ID for funded Course # Gender: Gender # Nationality: Nationality Full Name: (as in NRIC/FIN) Full Name (as in NRIC/FIN) # Date of Birth: (dd/mm/yyyy) Date of Birth Ä Place of Birth: Place of Birth # Race: Race # Residential Status: Residential Status Mailing Address: (Optional) Mailing Address 1 " PE Number: (if applicable) PE Number Mailing Address 2 · Email Address: Email Address · Mobile Number: Mobile Number # Highest Qualification: Highest Qualification Employment Status: (Optional) Employment Status PART C: PAYMENT |_| By Bank Transfer Bank Name: United Overseas Bank Limited Bank Branch: UOB Main Address: UOB Plaza 1, 80 Raffles Place, Singapore 048624 Account Name: Singapore Institute of Power and Gas Pte Ltd Bank Code: 7375 Branch Code: 1 Account Number: 451-302-969-6 Swift Code: UOVBSGSG |_| By Vendors@Gov Business Unit Code Business Unit Code Attention to Attention to |_| By Cheque Cheque Number Cheque Number Issuing Bank Issuing Bank Note: Please indicate company name and invoice number behind the cheque Cheque shall be made payable to SINGAPORE INSTITUTE OF POWER AND GAS PTE LTD and mailed to: SP Group, 2 Kallang Sector, Level 2, Singapore 349277 Attn: Singapore Institute of Power and Gas, Training Ops |_| NETS Please make payment at our reception at 1A Woodleigh Park, Level 1 (SPTI) Singapore 357874 Operating hours: Monday – Friday: 9am – 12pm, 2pm – 5pm Closed on weekends & public holidays PART D: DECLARATION I hereby declare that the following requirements are met: |_| Pass in English at GCE ‘O’/’N’ Level or equivalent |_| I have met the course pre-requisite (where applicable) PART E: RPERSONAL DATA PROTECTION ACT |_| By submitting and signing this registration form, I hereby declare that all information given in this form is true and accurate, and I agree to the terms and conditions stated below. |_| I acknowledge and agree that SIPG may collect, use and disclose to any third party any and all particulars relating to my/our personal information for the purposes of (i) providing the requested services in respect of the course(s), (ii) billing and account management (including debt collection or recovery); (iii) conducting surveys or obtaining feedback; (iv) informing me/us of services and offers by SIPG, its related entities and business affiliates (unless I/we duly inform you otherwise); and (v) complying with all applicable laws and regulations, and business requirements. Name: Name Signature: Date: Date PART F: INDEMNITY FORM |_| I declare that: 1) I am physically fit to participate in the course set out above and that I have not been advised otherwise by a qualified medical professional. 2) I, for myself, my heirs, executors, administrators, successors and/or assigns hereby release, waive and forever discharge Singapore Power Ltd and its subsidiaries, their respective servants and/or agents (“SP Group”), of and from any and all claims, demands, proceedings, costs, expenses, liabilities, loss or damage (whether direct or consequential), actions or causes of actions, whether in law or in equity, in respect of death, injury, loss or damage to my person or property howsoever caused, arising or to arise by reason of my participation in the course, whether prior to, during or subsequent to the course, and notwithstanding that the same may have been contributed to or occasioned by the negligence of the aforesaid. I further undertake to hold harmless and agree to indemnify all the aforesaid from and against any and all liability incurred by any or all of them arising as a result of, or in any way connected with, my participation in the course. TERMS AND CONDITIONS: 1) The company and individual applicant has read and understood the terms of the course information and registration form. 2) The information collected on this form is used for course registration, account servicing of course-related activities and/or for application of course-related funding to appropriate funding agencies. 3) This registration form must be submitted to SIPG at least 3 weeks before course commencement. 4) Payment must be made to SIPG before the due date of tax invoice. 5) SIPG reserves the right to amend any details relating to the course without any prior notice. 6) Request for withdrawal/transfer/replacement must be made in writing at least 5 working days before course/programme commencement and are subjected to approval by SIPG. Administrative charges of $50 (before prevailing GST) will be imposed for each approved request/pax. 7) Trainees need to achieve 75% attendance per module to be eligible to sit for the exam. 8) Trainee shall be bound by the terms and conditions of any applicable funding scheme as approved by SIPG. a. Funding grant is only applicable to Singapore Citizen, Singapore Permanent Resident and Long-Term Visit Pass plus. Trainees need to achieve 75% attendance per module, sit and pass all exams to be eligible for funding. b. In the event that the trainee fails to meet any of the requirements set under the funding scheme or has been granted funding for the same course before, thereby resulting that his/her funding application is rejected by the funding agency, the trainee is liable to pay the balance of the full course fee to SIPG. For trainees who are making payment via SFC and withdraw during the programme, you will be required to make payment in full via non-SFC payment methods. c. Absence due to valid reasons[footnoteRef:1] will not be counted as part of the 75% attendance requirements. Trainees will need to provide supporting documents for any absence due to valid reasons within 3 working days from date of absence. For non-valid reasons[footnoteRef:2], it will consist of all other reasons not covered under the valid reasons. Trainees will not be allowed to take the assessment if they do not meet the 75% attendance requirement. [1: Valid reasons refer to medical leave, hospitalization leave and compassionate reason.] [2: Non-valid reasons include work commitment, reservist, overseas trip (business/personal), not prepared for exam & etc.] d. There will be no postponement/replacement of schedule allowed for any session missed without valid reasons. e. Trainees will be allowed ONE re-assessment for each assessment component. Re-assessment shall be taken within 60 calendar days from the module end date. Re-assessment fee of $100 (before prevailing GST) will be applicable to each assessment component. In the event that the trainees do not pass the re-assessment or fail to take the re-assessment within 60 calendar days from end of the module, trainees will need to re-enrol for the module with full module fee. 9) Video and/or photographs of trainees may be taken at the event for SIPG’s marketing materials and other publications. SIPG-FORM-006 (V2) Page 1 Address: SP Group, 2 Kallang Sector, Singapore 349277 ● Main Line: 6916-7930 ● Email: training-institute@spgroup.com.sg