Application Form

Please fill in all * Mandatory Fields

Category of Membership applied for

OrdinaryAssociate

* Company Name

* Business Address

* Telephone

Fax

Head Office Address

Branch Office Address

* Email

Website

Nature of Business

Please tick one of the following applicable to the status of your company:

Private Limited CompanySole-ProprietorshipPartnership

Date of Incorporation / Formation

For private limited company, please state the authorised and paid up capital

Capital (S$) Authorised:

Capital (S$) Paid Up:

Shareholders/Partnership

Local %

Foreign %

* Number of Employees (excluding Directors)

Number of Directors/Partners

Singapore Citizens:

Foreigners

* Name of Managing Director / Manager / Sole-Proprietor

*NRIC / Passport No. of Managing Director / Manager / Sole-Proprietor:

* No. of years in ship supply business:

Office Space

Office Area (sq metres)

Located at (Address)

Warehouse

Warehouse Area (sq metres)

Located at (Address)

Nominated Representative

* Name

* NRIC / Passport No.

* Designation

Categories of the Ship Supply Trade engaged in (Please Tick Accordingly)

Deck / Engine / Cabin storesProvisions / Bonded storesShip’s sparesTo others (Please Specify)

Others (Please Specify)

Parties to which supplies are made (Please Tick Accordingly)

Direct to ship-owner / vesselsTo ship chandlersTo ship yardTo others (Please Specify)

To others (Please Specify)

* Please tick the box to Confirm

I/We, the aforementioned applicant do hereby apply for *Ordinary / Associate Membership of Singapore Association of Ship Suppliers. I/We undertake, upon acceptance as such member, to abide by all the Rules, Regulations, By-Laws and the Constitution of the Association.

I/We also declare that the Directors/Partners/Nominated Representative/Sole-proprietors have no criminal records whatsoever and I/we welcome any verification by Council Members of the Association.