Registered Address: 21 Tampines Avenue 1 Singapore 529757 Membership Application Form Applicant’s Details Name: Mr/Mrs/Miss/Mdm/Dr * (as in Finance records) Designation: Department/School: Home Address: Telephone No: (Home) Telephone No: (Office) NRIC/Passport No: Singapore ( Telephone No: (Mobile) ) TP iHRS Employee No (6 digits): TP Email Address: I hereby apply for membership to the Temasek Polytechnic Co-operative Society. I agree to conform to the by-laws and subscribe for 100 shares at $1/- per share which I will pay in full. Enclosed with this application is my cheque + for S$115.00. (Cost of Shares: $100.00 & Non-Refundable Application Fees: $15.00) Please write cheque payable to "Temasek Polytechnic Co-operative Society Limited". Send the completed form and cheque to the Secretary of TP Co-op c/o Assistant Secretary. + For Official Use Only Amount Received Bank / Cheque Number Date Received Number of Shares Approved Date Approved ______________ Signature/ Date S$ Membership Application Form Last Update: June 2013