MCIApplicationFeeForm_2011Intake.doc

INSTRUCTIONS
The following non-refundable application fee is payable when you apply for the
Master of Clinical Investigation programme:
Mode of Application
Application Fee
Online application
S$20.00 (inclusive of prevailing GST)
Paper application
S$40.00 (inclusive of prevailing GST)
· Payment by Post
- By cheque or bank draft made payable to ‘National University of Singapore’.
- Please write your name, contact number and the programme applied for at the back of the cheque. All cheques have to be valid for at least 3 months upon receipt by the school.
· Payment by Cash
Payment by cash will only be accepted at the Division of Graduate Medical Studies office during 8.30 am – 6.00 pm from Monday to Thursday & 8.30 am – 5.30 pm on Friday (Closed on Sat, Sun & P.H).

To be completed by Applicant:
Name of Applicant :

Mode of Application:
Telephone Number (Office) :

Telephone Number (Home):

Mobile Number :

Signature:

FOR OFFICIAL USE ONLY

1. SERIAL NO.: _________________________ 2. DATE RECEIVED: ___________________

3. FORM RECEIVED BY: _________________________ 4. CASH/CHEQUE/DRAFT NO.: ___________________

5. FEE PAID: S$_________________________ 6. OFFICIAL RECEIPT NO.: ___________________

7. DATA ENTERED BY: _________________________ 8. DATA ENTERED ON (DATE): ___________________

REMARKS (If any):
Please credit to GL 530132, WBS C-342-001-030-001 _______________________________________________________________________________________________________________

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