(This application form will take approximately 10-15 minutes to complete) Application of NEA’s No-Objection Letter for Workers’ Dormitory Important Note to Applicants: 1) If you are the owner of the subject factory, complete sections 1&2 of the application form only. 2) If you are not the owner of the subject factory, complete sections 1&2 and/or 3 of the application form. a) Please attach the authorization letter from the owner, complete with the owner’s signature & company stamp, if you are acting on the owner’s behalf. b) If you are planning to purchase or lease the industrial premises for workers’ dormitory use, please attach the sale or lease advertisement. 3) In addition to the application form, you need to attach a plan showing the location of the workers’ dormitory. The boundary of the premises & the exact location of the dormitory should be clearly indicated on the plan. 4) The application form & location plan shall be submitted via email to Central Building Plan Department (CBPD) of NEA, addressed to Lim_Jia_Fang@nea.gov.sg and Osman _Kutty@nea.gov.sg 5) For enquiries on the application status, please contact Mr Osman Kutty at telephone No.: +65 6708 6192 and Ms Lim Jia Fang at telephone No.: +65 6731 9919 6) In areas that are sewered, all sewage and used water generated from the proposed workers’ dormitory shall be discharged into the public sewer to the requirements and provisions of the Sewerage and Drainage Act. The use of on-site sewage treatment plant is not acceptable. In this respect, the developer/owner will have to seek PUB's (Water Reclamation Network) approval for connection to public sewer and for the allowable discharge rate before the proposed development is finalized. The application for PUB’s approval shall be submitted to the following address: Director, Water Reclamation (Network) Department, PUB 40 Scotts Road #14-00, Environment Building Singapore 228231 7) In areas that are unsewered, you are required to provide holding tank to collect and contain all sewage and wastewater generated from the workers’ dormitory. The sewage and wastewater shall be tankered away for disposal at a Water Reclamation Plant approved by PUB. 8) The sewage & sanitary drainage system shall be designed and operated in accordance to the requirements and provisions of the Sewerage and Drainage Act and its attendance regulations, and the Code of Practice on Sewerage and Sanitary Works. 9) The proposed workers’ dormitory shall comply with the relevant environmental health requirements stipulated in the Code of Practice on Environmental Health. A copy of the Code of Practice on Environmental Health may be downloaded from our website at http://app2.nea.gov.sg/code_practice_environmental_health.aspx. 10) The reply is limited to specific technical considerations under NEA’s purview only. For applications involving land use, you are also advised to obtain clearance from URA and other relevant technical authorities (eg. MOM, SCDF (Hazmat Department and Fire Safety & Shelter Department), JTC, etc.). 11) The minimum processing time for workers’ dormitory application is 7 working days. Section 1 (Landlord/Owner/Lessor’s Particulars) Landlord of Factory Premises : HDB / JTC / Others: ____________________________ (Note: If JTC is the landlord, kindly attach along their in-principle consent) Name of Company (if applicable): _____________________________________________ Name of Owner : _____________________________________________ Proposed Dormitory Address : _____________________________________________ Number of Workers : _____________________________________________ Mailing Address : _____________________________________________ Tel No / Fax No : _____________________________________________ Owner’s E-mail : _____________________________________________ Section 2 (For Dormitory Operator If You Are Not The Landlord/Owner/Lessor) (To fill in this portion if you are dormitory operator intending to convert the factory premises into a workers’ dormitory) Name of Company : _______________________________________________ Name of Contact Person : _______________________________________________ Mailing Address : _______________________________________________ Tel No / Fax No : ________________________________________________ E-mail : ________________________________________________ Note: For dorm operator, written permission/authorisation letter from owner must be attached with this application form. Section 3 (For Property Agent/Authorised Personnel) (To fill in this portion if you are an agent/authorised personnel acting on behalf of the factory owner/dormitory operator) Name of Agent’s Company (If applicable): _____________________________________ Name of Property Agent/Authorised Personnel: ___________________________________ Mailing Address : _______________________________________________ Tel No / Fax No : ________________________________________________ E-mail : ________________________________________________ Note: For agent/authorised personnel, written permission/authorisation letter from owner must be attached with this application form. The National Environment Agency (NEA) collects personal information to carry out its various functions and duties under the National Environment Agency Act (Cap 195) including the implementation of environmental and public health policies in Singapore and any other related purposes. I hereby consent to NEA’s use of the information provided by me in the course of any application I have made to the NEA, to facilitate the processing of such application for such purposes. I hereby further consent to NEA sharing the information in such application with other Government agencies, or non-government entities authorised to carry out specific government services, unless prohibited by legislation. In addition, I hereby declare that all the information submitted by me above is true and correct to the best of my knowledge and belief, and that I have not wilfully suppressed any material facts. I am fully aware that any suppression of material facts and/or false declaration by me may result in this application being refused or, if approved, in the suspension or cancellation of the clearance. Signature of Applicant Company Stamp Date