Submission of Application for Visa Electronically (SAVE)

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Print Visa Application Form 14

Visa application reference number: VSC037310SA01132008

贴护照型的近照
35毫米x45毫米
Affix a recent
Passport-sized
photograph here

Affix a recent
Passport-sized
photograph here

Notes:
**Delete where appropriate

FORM 14
IMMIGRATION ACT [CHAPTER 133, SECTION - 55(1)]
PASSPORT ACT [CHAPTER 220, SECTION 3(1)]

APPLICATION FOR ENTRY VISA

PART I - PARTICULARS OF APPLICANT

申请者的个人资料

Foreign Identification No. (FIN):
(leave blank if not applicable)

Sex: FEMALE

性别

Date of Birth: 30/10/1963

出生日期 DD日/MM月/YYYY年

For Malaysians Only

Identity Card No:
Colour: *	Red	Blue

Marital Status: MARRIED

婚姻状况

Name: 姓名 Family name/Surname 姓氏	BOJJIREDDY
Given Name 名字	KRISHNAVENI
Alias 别名 : Family name/Surname 姓氏
Given Name 名字 (leave blank if not applicable)

Name in Chinese Characters
(If applicable)

中文姓名

Country of Birth: INDIA

出生国

State / Province of Birth: ANDHRA PRADESH

出生州属/省份

Race: INDIAN

种族

Nationality: INDIAN

国籍

Religion/Denomination: HINDU

信仰/教派

Type of Travel Document Held: OFFICIAL PASSPORT 所持旅行证件的类别
Travel Document No: G5481755 旅行证件编号
Travel Document Issue Date: 27/09/2007 签发日期 DD日/MM月/YYYY年	Expiry Date: 26/09/2017 有效期至 DD日/MM月/YYYY年
Country of Issue: INDIA 签发国
Place of Issue: HYDERABAD 签发地

Disembarkation / Embarkation form no.:
(This form is the immigration white card issued to arriving foreigners)

---

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Visa application reference number: VSC037310SA01132008

PART I (continued)

Address in Singapore 在新加坡的住址
Block/House No.: 大牌/门牌		Floor No.: 楼层	Unit No.: 单位号码	Postal Code: 邮区
	871	02	55	520871
Street Name: 街名	STREET - 84 , TAMPINES			Tel No: 67814172 电话
Building Name: 大厦名称	BLOCK-871

Address in Country of Origin 在所属国的住址
Country of Origin: INDIA 所属国
State / Province of Origin: ANDHRA PRADESH 所属州属/省份
Address: 住址	4-219-T, BHAVANI NAGAR, RAJAMPET, KADAPA, AP

PART II - OTHER DETAILS

其他资料

Occupation: 职位	PROFESSIONAL
Highest Academic / Professional Qualifications Attained: 考获之最高学历/专业资格		SECONDARY
Purpose of Visit: FAMILY TAKE CARER 到访之目的
Period of Visa Applied For: 3 MONTHS 逗留天数
Nationality of Spouse: Singapore Permanent Resident 配偶的国籍

List countries in which applicant has resided for one year or more during the last 5 years

请列下在过去5年里曾经居留1年或以上的国家

Period of Stay

居留期

Country

国家

Address

住址

From

从

至

INDIA

4-219-T, BHAVANI NAGAR, RAJAMPET, KADAPA, AP

2000

2008

PART III - ANY ANTECEDENT OF APPLICANT

(a) Have you ever been refused entry into or deported from any country, including Singapore? 您是否曾经被任何国家拒绝入境或遣送回国，包括新加坡?	NO
(b) Have you ever been convicted in a court of law in any country, including Singapore? 您是否曾经被任何国家的法庭定罪，包括新加坡?	NO
(c) Have you ever been prohibited from entering Singapore? 您是否曾经被禁止进入新加坡?	NO
(d) Have you ever entered Singapore using a different passport or name? 您是否曾经使用不同的护照或姓名进入新加坡?	NO

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Visa application reference number: VSC037310SA01132008

PART IV - DECLARATION BY APPLICANT

申请者声明

I hereby declare that all the particulars furnished by me in this application are true and correct.
I undertake not to misuse controlled drugs or to take part in any political or other activities during my stay in Singapore which would make me an undesirable or prohibited immigrant under the Immigration Act.
I undertake to comply with the provisions of the Immigration Act and any regulations made thereunder or any statutory modification or re-enactment thereof for the time being in force in Singapore.
I undertake not to involve in any criminal offences in Singapore.
I undertake not to indulge in any activities which are inconsistent with the purpose for which the immigration passes have been issued.
I further undertake not to be engaged in any form of employment, business or occupation whilst in Singapore without the written consent of the Controller of Immigration.
I am aware that overstaying or working illegally in Singapore is a serious offence and on conviction, the penalties may include mandatory imprisonment and caning.
I understand that if the Controller of Immigration is satisfied that I or any member of my family breaches this undertaking or becomes an undesirable or prohibited immigrant, he will cancel my immigration pass and the passes of the members of my family, and we may be required to leave Singapore within 24 hours of such cancellation.
I understand that this application for and possession of a visa does not guarantee entry into Singapore and permission to enter is entirely discretionary at the point of entry.
I give my consent for your department to obtain and verify information from or with any source as you deem appropriate for the assessment of my application for immigration facilities.
	________________ Date	________________________ Signature of Applicant

本人谨此声明，本人在这份申请书里所提供的一切资料均属实与正确。
本人保证在居留新加坡期间不滥用受管制药物，或参加任何政治性活动或其他足以使本人成为在移民法令下不受欢迎或被禁入境人士的活动。
本人保证遵守移民法令的规定以及该法令下的任何条列，或新加坡现行的对该法令所作的任何法定修改或重新制定。
本人保证在新加坡期间不涉及任何刑事罪行。
本人保证不沉溺于任何不符合贵局签发移民证件原意的活动。
本人进一步保证，不在未经移民与关卡局总监书面准许的情况下，于居留新加坡期间以任何形式受雇于人，从商或就业。
本人知道，在新加坡逾期居留或非法工作是很严重的罪行，而且罪名成立时的惩罚可能包括强制性监禁和鞭刑。
本人明白，如果移民与关卡局总监确信本人或本人任何一名家庭成员违背了这份担保书或成为不受欢迎或被禁入境人士，他将取消我与我家人的移民证件，而我们可能必须在证件被取消后24小时之内离开新加坡。
本人明白，提呈这份签证申请书以及持有签证都不能成为入境担保，本人能否入境，全视临入境前的情况而定。
本人同意让贵局向任何视为恰当的消息来源获取或核实资料，以便对本人的移民证件申请作出评估。
	________________ 日期	________________________ 申请者签名

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PART V - DECLARATION BY LOCAL SPONSOR (Not applicable if you are applying for Entry Visa only)

本地担保人声明(不适用于只申请入境签证者)

(A local sponsor is required to complete either Section A or Section B below)

(本地担保人须填写组别甲或乙)

SECTION A - For application sponsored by a company only.

组别甲 - 只适用于由公司担保的申请书

Name and Address of Company:

公司名称与地址

We hereby sponsor this application and certify that it is made for the purpose as stated by the applicant.
The statement made in this application are true and correct.
We shall be responsible for the cost of the applicant's repatriation and maintenance pending such repatriation, if necessary.

我们谨此为这份申请书作担保,并证实这项申请是为申请者所填写的意向而提出的.
这份申请书里所作的各项声明均属实与正确.
倘若申请者有被遣返的必要,我们将负担其被遣返的费用及其等候遣返期间的生活费.

________________________
Signature of person acting
on behalf of the Company/Firm
and Date

公司/商号代表人签名与日期

Name, NRIC and Designation/Capacity

姓名，身份证号码与职位

Official Stamp of Company/Firm

公司/商号正式盖章

SECTION B - For application sponsored by an individual only.

组别乙 - 只适用于由个人担保的申请书

I, (name of sponsor), ________________________________________________ , holder of Singapore (Pink/Blue**) NRIC

No.: __________________ and residing at ____________________________________________________________________
Declare that:

The applicant, ___________________________________________________ is my
	parent
	husband / wife / son / daughter **
	other (Please specify) _______________________________

I hereby sponsor this application and certify that it is made for the purpose as stated by the applicant.

The statements made in this application are true and correct.

I shall be responsible for the cost of the applicant's repatriation and maintenance pending such repatriation, if

necessary.

本人,(担保人姓名), ________________________________________________ , 持新加坡(粉红色/蓝色**)

身份证号码: __________________ 居住于 ____________________________________________________________________
谨此声明:

申请者, ___________________________________________________ 是本人的
	父母
	丈夫/妻子/儿子/女儿**
	其他(请详细说明) _______________________________

本人谨此为这份申请书作担保,并证实这项申请是为申请者所填写的意向而提出的.

这份申请书里所作的各项声明均属实与正确.

倘若申请者有被遣返的必要,本人将负担其被遣返的费用及其等候遣返期间的生活费.

________________
Date

日期

________________________
Signature of Sponsor

担保人签名

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- 4 -

Controller of Immigration Singapore	Name of Local Contact: VATHSAVAI BHASKARA RAJU
	Address:	BLOCK-871, STREET-84, UNIT#02-55,
	Telephone No.: 81126939
	Date: 22/04/2008
Dear Sir LETTER OF INTRODUCTION FOR VISA APPLICATION The applicant for the visa, BOJJIREDDY KRISHNAVENI *(name of applicant), of INDIA (country), holder of passport/travel document no. G5481755 is coming to Singapore from INDIA (country of embarkation) for the purpose of FAMILY TAKE CARER (e.g., holiday, transit, business, meeting, exhibition, visiting friend & relatives, employment, education; for others, please specify). The applicant is my 81188449 (e.g., father, mother, brother, sister, son, daughter, spouse, business partner; for others, please specify). Yours faithfully Only for application where Local Contact is an individual:*
_____________________________________ Signature of Local Contact		_______________________________ NRIC (Pink/Blue) No.
_____________________________________ Name of Local Contact
------------------------------------------------------------------------------------------------------------------------------------- Only for application where Local Contact is a company ___________________________________________ Signature of person acting on behalf of the company/firm
______________________________________ Name, NRIC No and Designation/Capacity		_______________________________ Official Stamp of company/firm
V39A

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