OVERSEAS INDUSTRIAL TRAINING PROGRAMME
LETTER OF UNDERTAKING & HEALTH DECLARATION FORM
(This form will take about 5 minutes to complete)
I ____________________________________ of _____________________ (Course/Year/Class) fully
understand that being selected for the Overseas Industrial Training at ________________________
from _______________ to _________________ (period of attachment) , it is my responsibility to ensure
that the following are adhered to : 1.
I possess an International Passport which is valid for at least six months.
2.
If I am a Singaporean male, I have to obtain an Exit Permit from MINDEF permitting me to be
attached overseas for the period required.
3.
Where applicable, I have obtained a valid entry visa and / or work permit for my attachment in the
overseas establishment (copy attached).
4.
I understand that students are covered under the Students’ Group Personal Accident Policy which is
payable:
4.1. Travelling 90 days or less: a capital sum of S$100,000 upon death and a medical
reimbursement of a maximum of S$100,000 overseas or 5% for return treatment per accident.
4.2. Travelling more than 90 days: a capital sum of S$500,000 upon death and a medical
reimbursement of a maximum of S$300,000 overseas or 5% for return treatment per accident
5.
I have purchased an insurance policy which covers me for the period of my stay overseas for
medical and hospitalisation.
6.
I have a valid return air ticket to the place of attachment overseas.
7.
I do not have any adverse medical history with regards to the overseas ITP trip.
8.
I understand that I am required to be financially and socially independent.
9.
I will complete my Log Book entries and supplement it with photographs where appropriate.
10. I will write an article (at least 1 A4 page length) regarding my ITP experience and overseas stay. I
will submit this article together with some photographs to the Industry Services Centre upon the
first week of the school term.
11. I will undertake to refund the full amount of overseas ITP Funding to Singapore Polytechnic if I fail
to complete the overseas ITP attachment.
_________________
Signature of student
_______________
Date of Birth/Age
_______________
Adm No
__________________
Tel/ Pger/ Handphone
(Below is applicable to students under 21 years old. Please obtain approval from your
parents/guardian)
I ______________________ * father / mother / guardian give my consent for my *son/daughter/ward
to be involved in the Overseas Industrial Training Programme. I undertake to refund the full amount of
overseas ITP Funding incurred by Singapore Polytechnic to Singapore Polytechnic if my
son/daughter/ward fails to complete the overseas ITP attachment.
_________________________
Name of *parent/guardian
______________________
Signature & Date
This letter must be signed and submitted to the Manager, Industry Services Centre before leaving
Singapore for the place of attachment overseas. Failure to do so will render the attachment not
recognised by the Singapore Polytechnic.
IS-FRM-P05-110M
* Delete where inapplicable
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