AEMPLOYER'S COPY

IPA - S Pass G5092653U / 28 Jan 2015

PLAY BY EAR
245B VICTORIA STREET
SINGAPORE 188032

*00799806628012015*

09 Feb 2015

We have renewed
your pass

Please confirm
the details below
If you have any changes, send them to us
(with supporting documents) using iSubmit.
We will tell you if you need to reapply.

Dear Sir/Madam
CSN

We are pleased to inform you that PUTRI DAMARWATI

ENDAH's S Pass has been renewed for another 24 months. This
In-Principle Approval is valid until 10 Apr 2015.

53028683A - PTE - 01
FOREIGN EMPLOYEE'S NAME

PUTRI DAMARWATI ENDAH

DATE OF BIRTH

This letter lists the employment details for you to confirm and the
next steps you need to take so that an S Pass card can be
issued.

04 JUN 1982
SEX

FEMALE
NATIONALITY

INDONESIAN
Please complete all the steps on the next few pages before this
IPA expires. Otherwise, we will withdraw the approval and you
will need to send her home.
Yours sincerely

PASSPORT NO

B0027873
FIN

G5092653U
DATE OF APPLICATION

28 JAN 2015
OCCUPATION

Penny Han (Mrs)

Controller of Work Passes

MUSIC INSTRUCTOR
MONTHLY LEVY

S$315 (Tier 1) or S$550 (Tier 2)

You must comply with the conditions under the Employment of Foreign Manpower Act and
conditions of the S Pass, as well as the Work Injury Compensation Act. Otherwise, we can
cancel the S Pass, prosecute you and withdraw your permission to employ S Pass holders.
You can read the rules at www.mom.gov.sg.
Ministry of Manpower Work Pass Division
Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

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IPA - S Pass G5092653U / 28 Jan 2015

EMPLOYER'S
EMPLOYER'S COPY
COPY

What you need to do to get the S Pass card:

Next steps
Send them the pass holder's copy
of the IPA letter.
If they require a visa, the pass holder's IPA contains a
pre-approved single journey visa for their use - a
charge of S$30 for a multiple journey visa (if applicable)
will have to be made to MOM later.

Ask them to go for a medical exam which

includes HIV Test.
The doctor must complete the attached form.
This medical should not be taken as any guarantee
of your new employee's health. Medicals must
not be more than three months old when the
S Pass is collected.

Tell us of any change in their

address using EPOL.
The address we have is:
53 SIMS PLACE
#05-154
SINGAPORE 380053

Buy and maintain a minimum medical

insurance coverage of S$15,000 per year
for each S Pass holder's inpatient care and
day surgery.
Provide the insurance details when you issue the
S Pass using EP Online or update us through the "Medical
Insurance Function" in WP Online.

This approval does not exempt the pass holder from compliance or registration required
under the respective professions, for which professional registration to practise in
Singapore is a prerequisite (e.g. medicine, dentistry, pharmacy, architecture, law, etc).
Ministry of Manpower Work Pass Division
Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

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IPA - S Pass G5092653U / 28 Jan 2015

EMPLOYER'S
COPY
EMPLOYER'S COPY

Next steps
Login to EPOL to ask for their
S Pass card to be issued.
This will cost S$80.
If you need help, search for the "Step-by-Step Guide to
Issue Pass via EP Online" on the MOM website.

Ministry of Manpower Work Pass Division

Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

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IPA - S Pass G5092653U / 28 Jan 2015

EMPLOYER'S
COPY
EMPLOYER'S COPY

Have these documents ready before you ask for their S Pass card to be issued. (The pass holder
should bring this page along when they report for card registration)

This In-Principle Approval letter.

The pass holder's original passport / travel document, which must have a remaining validity of at
least 7 months (where the validity is less than or equal to the period granted for your S Pass,
please note that the S Pass will only be issued up to 1 month before the expiry date of your
passport / travel document.
The completed medical examination form.
The original and completed Declaration Form duly signed by the pass holder, local Employer /
Sponsor and if applicable, the Third Party user who submitted the application on behalf of the local
employer / sponsor.
If you are the new employer / sponsor of existing Work Pass, Dependant Pass or Long Term Visit
Pass holders, they must cancel their current pass first before you can ask for their new pass to be
issued.
Ask for the Employment Pass or S Pass to be issued first, before you proceed with their
Dependant or Long Term Visit Passes.

Ministry of Manpower Work Pass Division

Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

Page 4 of 4

IPA - S Pass G5092653U / 28 Jan 2015

EMPLOYER'S COPY

DECLARATION FORM

Declaration Form
This form must be submitted during pass issuance. If there are any discrepancies in this Declaration Form,
the correct information must be provided using iSubmit at www.mom.gov.sg/isubmit before the collection of
the pass. The application will be re-assessed and we will inform you of the outcome.

PART A

DECLARATION BY FOREIGN EMPLOYEE

Name: PUTRI DAMARWATI ENDAH

FIN: G5092653U
Date of Application: 28 JAN 2015
Date of Birth: 04 JUN 1982
Nationality: INDONESIAN
Educational details:
Country of Awarding Body/Institution/University: INDONESIA
Name of Awarding Body/Institution/University: UNIVERSITAS SATYA WACANA, CENTRAL JAVA
Main Campus or Affiliating College Attended: Qualification: BACHELOR'S DEGREE
Faculty: MUSIC
Mode of study: FULL-TIME
Period of study: 01 AUG 2002 to 05 APR 2007
Name of Employer/Sponsor: PLAY BY EAR
Occupation: MUSIC INSTRUCTOR
Fixed Monthly Salary (S$): 3,750
I declare that:

I have never been refused entry or deported from any country.

I have never been convicted in a court of law in any country.

I have never been prohibited from entering Singapore.

I have never entered Singapore using a different passport issued by a different country.

I have never entered Singapore using a different name.

I have never been a citizen or permanent resident of Singapore.

I have read and understood the conditions of S Pass in the Employment of Foreign Manpower (Work
Passes) Regulations c.91A, available at MOM counters or at www.mom.gov.sg.

Declaration Details: Nil

I consent, for the purpose of assessing this Application for an S Pass and the administration of work pass
matters,

Ministry of Manpower Work Pass Division

Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

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IPA - S Pass G5092653U / 28 Jan 2015

EMPLOYER'S COPY

DECLARATION FORM

for the Government of Singapore and statutory authorities thereof to obtain from and verify information
with any person, organisation or any other source, and further,

to the release of all information thereby obtained to the Government of Singapore, statutory authorities
and their agents thereof.

I hereby give my consent for the Comptroller of Income Tax to verify my income stated in my current and
renewal applications, based on my assessment record for the current Year of Assessment, for the Controller
of Work Passes. In the event my assessment record for the current Year of Assessment is not available or
finalised at the point of verification, I understand the Comptroller of Income Tax will verify my income against
my assessment record for the two previous Years of Assessment. I also hereby give my consent for the
Comptroller of Income Tax to thereafter communicate the results of the verification to the Controller of Work
Passes.
I declare that the information in this Renewal for an S Pass, Declaration Form and any appeals are, to the
best of my knowledge, true and correct; and that all documents submitted in support for this Renewal,
Declaration Form and any appeals, are true copies of the originals.

Name of Foreign Employee:

Signature of Foreign Employee:

FIN:
Date

(DD-MM-YYYY)

Ministry of Manpower Work Pass Division

Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

Page 2 of 4

IPA - S Pass G5092653U / 28 Jan 2015

EMPLOYER'S COPY

PART B

DECLARATION FORM

DECLARATION BY EMPLOYER / LOCAL SPONSOR

I declare that I have read and understood the conditions and regulatory conditions of S Pass in the
Employment of Foreign Manpower (Work Passes) Regulations available at MOM counters or on our MOM
website and I further declare that I am authorised to bind PLAY BY EAR, the employer/sponsor or PUTRI
DAMARWATI ENDAH to the following:

The employer/sponsor shall keep copies of the education certificates of the foreign employee declared
in this application for an S Pass for the duration of the foreign employee's employment with the
employer/sponsor.

Where the foreign employee has a diploma or degree from the People's Republic of China, the
employer/sponsor has verified the authenticity using one of the following channels:
a. CHESICC - China Higher Education Student Information and Career Center (http://job.chsi.com.cn)
b. CDGDC - China Academic Degrees and Graduate Education Information (http://www.cdgdc.edu.cn)
c. Dataflow - (http://www.dataflowgroup.com)
The employer/sponsor shall keep a printout of this verification throughout the foreign employee's
employment.

The employer/sponsor has ensured that the foreign employee fully understands the contents of Part A
of the Declaration Form and that it was signed by the foreign employee.

The employer is aware that the Controller of Work Passes uses its Central Provident Fund contribution
information to determine the number of local workers employed by the employer hence determining
the number of foreign employees that it may employ. The employer has ensured that its Central
Provident Fund contribution record of payments as employer is required under the Central Provident
Fund Act (Cap. 36) only reflects every citizen or permanent resident of Singapore who is employed by
the employer and at the appropriate contribution prescribed by law. The employer has not made any
voluntary CPF contributions for the purposes of inflating his foreign employee entitlement.

The employer/sponsor, for the foreign employee named in Part A of this Declaration Form, undertakes to:

bear responsibility for the foreign employee's upkeep and maintenance in Singapore.

indemnify the Singapore Government for any charges or expenses which may be incurred by the
Government in respect of the repatriation of the foreign employee or any of the foreign employee's
dependants.

provide all reasonable assistance to the foreign employee to comply with any quarantine and medical
surveillance imposed on the foreign employee under Regulation 8(2A) and 8(4) of the Immigration
Regulations c. 133.

I consent, for the purpose of assessing this Renewal for an S Pass and the administration of work pass
matters,

for the Government of Singapore and statutory authorities thereof to obtain from and verify information
with any person, organisation or any other source; and further,

Ministry of Manpower Work Pass Division

Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

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IPA - S Pass G5092653U / 28 Jan 2015

EMPLOYER'S COPY

DECLARATION FORM

to the release of all information thereby obtained to the Government of Singapore, statutory authorities
and their agents thereof.

I declare that the information in this Renewal for a S Pass, Declaration Form and any appeals are, to the
best of my knowledge, true and correct; and that all documents submitted in support for this Renewal,
Declaration Form and any appeals, are true copies of the originals.
Name of Authorised Representative:

Organisation Stamp:

NRIC:
Designation:
If you do not have a stamp, please attach a letter using your
company letterhead to confirm that this representative is
authorised.

Signature:

Date

(DD-MM-YYYY)

Ministry of Manpower Work Pass Division

Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

Page 4 of 4

IPA - S Pass G5092653U / 28 Jan 2015

MEDICAL FORM
EMPLOYER'S COPY

Medical Examination Form

This form is to be completed by a qualified doctor and returned to the foreign employee.
The foreign employee must produce his/her passport and the In-Principle Approval letter from the Ministry
of Manpower to the doctor.
The foreign employee must submit this report to the Ministry of Manpower during card registration.

A. Personal Particulars
Name (as in the passport): PUTRI DAMARWATI ENDAH
Sex: F

Date of Birth: 04 JUN 1982

Medical: HIV Test

FIN: G5092653U

Nationality: INDONESIAN

Passport No.: B0027873

B. Clinical Examination

Remarks:

1. Cardiovascular System

Normal

Abnormal

2. Respiratory System

Normal

Abnormal

3. Abdomen

Normal

Abnormal

4. Neurogical

Normal

Abnormal

C. Other Tests
Chest X-ray*:
Any evidence of active TB detected?

No

Yes

Examinee is pregnant

[* Pregnant women are exempted from Chest X-ray.]

HIV(AIDS):

Negative / Non-Reactive

Positive / Reactive

Certification
I certify that I have examined the above-named person and my findings are as above.
I also certify that he/she is

Fit

Unfit

for employment.

Name of Examining Doctor (in block letters):

Clinic's Stamp & Address:

Signature of Examining Doctor:

Telephone No.:

Date

(DD-MM-YYYY)

If the examinee fails the medical examination, the In-Principle Approval will be deemed as
withdrawn. If he/she is in Singapore, he/she must leave before the Short Term Visit Pass
expires.
Ministry of Manpower Work Pass Division
Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

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IPA - S Pass G5092653U / 28 Jan 2015

HOLDER'S
A PASSCOPY

PUTRI DAMARWATI ENDAH

PLAY BY EAR
245B VICTORIA STREET
SINGAPORE 188032

*00799806628012015*

09 Feb 2015

Your renewal
is approved

What happens next?

Please follow these simple steps and
get your S Pass. There are more detailed
instructions on the next page(s).

Dear PUTRI DAMARWATI ENDAH,

We are pleased to inform you that your S Pass renewal has been
approved.
Your employer must ask for your S Pass to be issued as soon as
possible. If it is not issued by 10 Apr 2015, we will withdraw this
approval.

CHECK YOUR DETAILS

Make sure the employment details
overleaf are correct. If not, please
inform your employer immediately.
COLLECT YOUR CARD
Make sure your employer arranges for
your S Pass to be issued before 10 Apr
2015.

Yours sincerely

Penny Han (Mrs)

Controller of Work Passes

This letter does not grant you stay in Singapore. You need to ask for your pass to be issued
straightaway.
Ministry of Manpower Work Pass Division
Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

Page 1 of 2

W
PASS HOLDER'S
COPY

IPA - S Pass G5092653U / 28 Jan 2015

Check your employment details.

If you find a problem, please contact your employer straight away.
YOUR NAME

DATE OF BIRTH

SEX

PUTRI DAMARWATI ENDAH

04 JUN 1982

FEMALE

NATIONALITY

PASSPORT NO.

FIN NO.

INDONESIAN

B0027873

G5092653U

DATE OF APPLICATION

OCCUPATION

MEDICAL REQUIRED

28 JAN 2015

MUSIC INSTRUCTOR

HIV Test

PERIOD GRANTED (MONTHS)

EMPLOYER

24

PLAY BY EAR

BASIC MONTHLY SALARY

S$3,750

FIXED MONTHLY ALLOWANCES

FIXED MONTHLY SALARY

S$0

S$3,750

About your salary:

Your employer has declared that your fixed monthly salary of S$3,750 will not vary from month to month and
shall be paid to you regardless of performance on a monthly basis. It does not include overtime, bonus or
commission.

To get
your card

Once your employer has

asked for your S Pass to be
issued, you will have to make
an appointment to complete
your card registration.
Please book your appointment
as early as possible.

These steps must be completed or we will withdraw the approval and you have to leave
Singapore. This approval does not exempt you from compliance or registration required
under the respective professions, for which professional registration to practise in
Singapore is a prerequisite (e.g. medicine, dentistry, pharmacy, architecture, law, etc).
Ministry of Manpower Work Pass Division
Web http://www.mom.gov.sg

Contact Us http://www.mom.gov.sg/contact

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