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TEMASEK POLYTECHNIC STUDENT AND ALUMNI AFFAIRS DEPARTMENT (SAA) APPLICATION FOR ALUMNI CARD
INSTRUCTIONS : 1(a) For application of Alumni Card, please submit the completed form to: Temasek Polytechnic, Student & Alumni Affairs Department, 21 Tampines Ave 1, Blk 30, Student Development Centre, #02-04, Singapore 529757 (b) For application of Alumni Card that involves payment, please submit application form to SAA for verification before proceeding to: Temasek Polytechnic, One-Stop Service Centre, 21 Tampines Ave 1, Blk 9, #02-06, S529757 Payment can be made by Cash, Nets, Cash Card or Cheque. A crossed cheque should be made payable to " Temasek Polytechnic" . Non-transferable and post dated cheques will not be accepted. 2 When submitting form by post, please include a postage paid 50-cent self-addressed envelope (dimension size of 110 X 220 mm). 3 If you recover the lost card, you must immediately cut it in half without using it. 4 Estimated processing period is about 15 working days. SECTION A : TO BE COMPLETED BY GRADUATE Name (as in NRIC using CAPS)

RECENT PASSPORT SIZED COLOUR PHOTO

NRIC No (For Singaporean/SPR only) : S Matriculation/Admission No :

Month/Year of Graduation

/
Course Title :

Local Mailing Address : B L K # -

S Contact Numbers : H 6 O 6 X Email Address: (Personal)

HP

(Office)

Reason for card application : Pls tick (a ) Free New Card (Only applicable to 2010 full-time fresh grads who apply before 31 Dec 2010) New Application ($4.00) 1st Card Replacement ($10.00) 2nd or Subsequent Card Replacements ($15.00)

Reason for Card Replacement : Pls tick (a) 1. Lost 2. Defaced * (Cut your Damaged / Defaced Card.) Payment Mode : Pls tick (a ) By Cash, Nets or Cash Card $ By Cheque $ Cheque No : (Pls state bank and cheque no. eg:POSB XXXXXX) DECLARATION BY GRADUATE : I declare that all particulars and information given above are true and accurate. Signature : SECTION B : FOR OFFICIAL USE ONLY
DD/MM/YY

3. Damaged

Date :

1. FNA 2. SAA

Receipt No:
MM/YY

Date of Payment:
DD/MM/YY

Membership wef:

Date of Processing:

Bar Code no :

Issued by:

Section C : ALUMNI CARD ACKNOWLEDGEMENT SLIP (To be retained by graduate for access to TP facilities. ) For FNA Processing : Official Stamp

Mr/Ms
Name of Card Applicant Date of Application/Payment : Portal: www-alumni.tp.edu.sg Facebook: facebook.com/ temasekpolytechnicalumni Page 1 of 2 Alumni Hotline: 6780 5353 Hotmail: alumni@tp.edu.sg

NRIC No (For Singaporean/SPR only) SAA/ALUMNI 001 VER.7 Last Updated 20 October 2010

Adm No.

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SAA/ALUMNI 001 VER.7 Last Updated 20 October 2010

Portal: www-alumni.tp.edu.sg Facebook: facebook.com/ temasekpolytechnicalumni Page 2 of 2

Alumni Hotline: 6780 5353 Hotmail: alumni@tp.edu.sg

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SECTION D : FOR SAA OFFICIAL USE ONLY

Date of Checking:
DD/MM/YY

Step 1:

Checked card application status

DD/MM/YY

Step 2: Contacted alumnus for payment (Application to be filed till action taken by alumnus for payment) Date of Processing:
DD/MM/YY

Step 3: Step 4: Step 5: Step 6:

Processed in APS Intranet Updated personal particulars in APS Intranet Scanned photo (if any) Date of Printing:
DD/MM/YY

Date of Updating:
DD/MM/YY

Card printed Date of Mailing:

DD/MM/YY

Step 7: Card mailed out (Application form to be filed accordingly)

SAA/ALUMNI 001 VER.7 Last Updated 20 October 2010

Portal: www-alumni.tp.edu.sg Facebook: facebook.com/ temasekpolytechnicalumni Page 3 of 2

Alumni Hotline: 6780 5353 Hotmail: alumni@tp.edu.sg