All Fields Are Mandatory and Must Be Completed in English in Clear BLOCK LETTERS
Application for Withdrawal from Entire Examination
(Applicable for 2017 Private Candidates only)
- This application form may take you 5 minutes to complete and will require the following information
- Candidate’s Personal Particulars
- All fields are mandatory and must be completed in English in clear BLOCK LETTERS.
- Application for withdrawal must reach SEAB before the start of the year-end written examination.
- Candidates may be given a 50% refund of subject fee paid (inclusive GST) if they submit their withdrawal requests to SEAB by 28 April 2017 for GCE N(T)- and N(A)-Levels and by 30June 2017 for GCE O-Level and GCE A-Level.
- For candidates who are entitled to a refund, the amount will be refunded to the candidate in approximately one month after approval by SEAB.
- No refund will be made to candidates whose requests are made after the respective deadlines.
- The completed form and supporting documents (if any) can be emailed to .
Section 1 - CANDIDATE’S PARTICULARS
NRIC/ FIN / Passport
/ ID Type (TICK () relevant box)
NRIC FIN Passport
Write in BLOCK letters and UNDERLINE surname/family name in the space below.
Examination Level (TICK () relevant box)
N(T)- and N(A)-Level O-Level A-Level
Section 2 - CANDIDATE’S CONTACT DETAILS
Tel No. / 6
/ Handphone No.
Block / House No.
/ Street Name
Unit No.
# / -
/ Postal Code
/ EMAIL Address:
______
Section 3 – REASON FOR WITHDRAWAL
Tick ()reason / Reason for Withdrawal / Supporting Documents to be submitted with application form
Admission to Tertiary Institutions / -Letters of acceptance issued by the tertiary institutions for admission to a full-time course
Medical Reason / -Medical documents (e.g Letter from doctor to certify that the candidate is unfit throughout the exam period)
National Services (please specify NS Enlistment date):
______/ -NS Enlistment LetterAND
-Certification letter from army unit to certify that the candidate is still serving NS during the year-end exam period.This period must coincide with the examination period that the candidate has registered for the exams.
Others (please specify reason):
______/ -Supporting documents (if applicable)
Section 4 – ALTERNATE PAYEE (only for application which entitles refund)
I, ______(name), ______(NRIC/FIN number), authorised the refund of my examination fee to be payable to ______(name),______(NRIC/ FIN number).
Alternate Payee’s address (if different from the above):______
______
Section 5 – DECLARATION
I confirm that I would like to withdrawal from the examination and all information in this form is correct. I acknowledge that
I would not receive any result or result slips/certificates for any subjects or components of subjects that they may have taken. If the results for these have already been released, for example, the mid-year written examination results, these results will be invalidated.
Signature : ______Date: ______
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Application for Withdrawal Form