Financial Assistance Application Form

Please fill up this form

Eligibility Criteria for FSS Financial Assitance

EA FSS may be able to help if you/your family member:

are looking for work or temporarily unable to work due to illness or have to care for children, elderly or other dependents
have a monthly household income of $1,900 and below or a per capita income of $650
have little or no family support, savings or assets to rely on for your daily needs
are a Singapore Citizen or Permanent Resident (at least one immediate family member in the same household must be a Singapore citizen)

Important Note:

Supporting documents are required.
Please keep the original copies of the supporting documents as the Eurasian Association, Singapore (EA) reserves the right to sight the original documents as necessary. Processing time would take approximately 4 weeks from the submission of all relevant supporting documents.

The approving body's decision is final.

Please upload the following documents below:

NRIC of all Adults in the Household
Birth Certificate of all Children in the Household.
Letter of appointment / termination / retrenchment(employment)
Doctor’s memo certifying fitness for work, and duration of the condition, if applicable:
Latest Utility / Service & Conservancy Charges / Rental Payment Bills - Where applicable.
Updated Bank Book / Latest Bank Statement. *
Latest CPF Contribution History and Latest payslip
Documents on assistance received from other organisation(s)

* Only Bank Statements reflecting the Bank, and Account Name, and Account No. with the Credit & Debit Transactions and Balance will be accepted.

Type of Application *

Upload File if necessary

File Upload 1

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File Upload 2

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File Upload 5

File Upload 6

File Upload 7

File Upload 8

File Upload 9

Attachment 10

Individual Prefix

Surname *

Name of Applicant (As per NRIC) *

NRIC No. *

Gender ID *

FEMALE MALE

Nationality *

Birth Date *

Ethnic Group *

Highest Qualification *

Marital Status *

Office No.

Home No.

Mobile No. (Home) *

Mobile No. (Secondary)

House / Block No. *

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

Postal Code *

Floor No. (Primary) *

Unit No. *

Designation *

Occupation *

Length / Period (years) Of Employment *

Bank Name *

Bank Account No. *

No. of School Going Children *

Total Members including Children in the Household *

Household Type *

Family Type *

Other Members Living in the Same Household

Salutations *

Name of Family Member (As per NRIC) *

Ethnic group *

Relationship to Applicant *

Date of Birth *

Current Gross Monthly Income *

Employment Type (Household Member) *

Designation (Household Member) *

Marital Status (Household Member) *

Highest Qualification (Household Member) *

Email (Household Member)

Office No. (Household Member)

Home No. (Household Member)

Mobile No. (Household Member)

Name of Family Member (As per NRIC)
Relationship to Applicant
Nationality
Ethnic group
NRIC No.
Date of Birth
Current Gross Monthly Income
Employment Type
Length/ Period
Highest Qualification
Marital Status
Email
Office No.
Home No.
Mobile No.

Other Family Members Particulars

Income

Household Income per Month

I - Net Salary after CPF ($) *

Living in the same house as of current

I - Net Salary (Family Members in the same Household) ($) *

Do include if any

I - CPF Retirement Scheme ($) *

I - Insurance Pay-Outs ($) *

I - Assistance from VWOs, SSO, FSCs & Other Agencies ($) *

I - MOE - FAS ($) *

I - Assistance from Friends and Relatives ($) *

I - Others Income ($) *

I - Household Income per Month - Total ($) *

I - State other income

Expenses

Household Expenditure per Month (Cash Payments Only)

E - HDB Monthly Rental / Mortgage Monthly Repayment / Fully Paid ($) *

Utility Bills etc.

E - Utilities ($) *

e.g. Meals Purchased

E - Daily Meals / Food (e.g. Meals Purchased) ($) *

Dry Rations, Groceries, Toiletries, etc. ($)

E - Household Expenses *

School Pocket Money, Transport, etc.

E - Education Expenses ($) *

E - Bank Loans / Hire Purchase - Repayments ($) *

E - Mobile ($) *

E - Internet ($) *

E - Other Expenditures ($) *

E - Medical Expenses - Children ($) *

E - Service and Conservancy Charges (S&CC) ($) *

E - Household Expenditure per Month - Total *

Total Household income / No. of Household Members = Per Capital Income

Per Capita Income

** If Others = Please State Agencies Name.

Any Other Information (If Applicable) *

Consent / Declaration

I declare that all the information provided in this form is true, correct and accurate to the best of my knowledge. I understand and acknowledge that if any of the information provided in this form is false or inaccurate, I will be liable to repay in full any subsidy and financial assistance granted inclusive of all administrative expenses.

Under the Personal Data Protection Act (PDPA), I grant the Eurasian Association, Singapore to use my personal information in processing this application and sharing with parties involved with this application.

Consent to Access OneCV Database

OneCV:
I understand that the following may be carried out, for the purposes of facilitating my application for financial or other assistance from your Agency:

my Personal Information** may be used to assess my and/or my household’s eligibility for such assistance to be provided by your Agency; and
my Personal Information may be used to render such assistance to me and/or my household by your Agency.
I give my consent to your Agency or person authorised by MSF to collect, share and use the Personal Information only for the purposes stated above.
This consent shall be governed and construed in accordance with the laws of the Republic of Singapore. [If assistance is rendered to the household]:
I confirm that all the named beneficiaries on whose behalf I have applied for assistance are aware of this application and acknowledge that their records may be shared in the manner stated above.

** Personal Information may relate to past, present or future matters, and includes my personal data (e.g. name, NRIC no.), personal data of my family members who may have received financial assistance and/or other types of assistance to date, and any other information about me or my family that is relevant for the Agency’s evaluation of my application for financial assistance.

All FSS Cases will be reviewed by our FSS Case Review Sub Community

Acknowledgement *

I agree

Name as per IC *

NRIC / FIN *

Application Date *

Click on the field below then on the signature screen, left-click and hold your mouse to sign

Applicant Signature *

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