| Last Date of Attendance * |
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| Name * |
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| NRIC/FIN * |
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Enter NRIC no. for S'porean/PR or Foreign Identification No.
(FIN) for Other citizenship |
| Local Address * |
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| Postal Code * |
Singapore
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| HandPhone No. * |
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| Email Address * |
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(Please provide your email address as you will be informed on the collection of Module Certificate and application status via email)
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| College of Study * |
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| Course Level * |
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| Course Title * |
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| Remarks(Optional) |
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I confirm that I am the applicant and that details given in the online application form for Module Certificate are true and correct.
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| Please check your application details are correct and print a copy of this page before you click on ‘Submit’. An acknowledgement screen will appear if your application is submitted successfully. |
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