Unit for Contract & Casual Workers (UCCW)
Membership Application Form
Membership Card Serial No (For Renewal): ______________________________________
PERSONAL PARTICULARS
Name in NRIC:
NRIC/FIN No:
Gender: Female
Male
Date of Birth:
Race:
(DD/MM/YYYY)
Chinese
Malay
Indian
Eurasian
Others (Specify): _______________________
Nationality:
Singaporean
Residential Status:
Marital Status:
No of Children:
Malaysian
Others (Specify): _________
Singapore Citizen
Permanent Resident
Employment Pass Holder
Work Permit Holder
Single
Others: _______________
Married
Age of Children: _________________________________
Highest Education Level
Primary & Below
Upper Primary
Lower Secondary
Upper Secondary
GCE ‘N’ Level
GCE ‘O’ Level
GCE ‘A” Level
Diploma
ITE NTC 2/NITEC
ITE NTC 3/NITEC
Intermediate
Other: __________________________
Contact Number
Handphone Number (HP) : ____________________
Home Number: _____________________
Email Address: ______________________________
Office Number: _____________________
ADDRESS IN SINGAPORE
Blk/House Number: ___________
Unit Number: _________________
Street Name: ____________________________________
Postal Code: _________________
YOUR JOB
Occupation : ____________________
Company Name (in Full) : ____________________________
Date Joined: _______________________
Type of Employment: Contract/Casual
Name of Previous Employer:________________
Monthly Gross Salary:
Below $300
$300 - $499
$500 - $999
$1000 - $1199
$1200 - $1499
$1500 - $1999
$2000 - $2499
$2500 - $2999
$3000 - $3999
$4000 - $4999
$5000 & above
Household Income: ___________________
Per Capita Income : ___________________
Number of People Living In the Same House: ___________
Are you a Union Member? : Yes
Name of Union : __________________
No
Skill Training & Upgrading
Do you want UCCW to contact you for subsidised training?
Yes
No
DECLARATION
This information given by me is true and correct. I Agree to the following:
PERSONAL PARTICULARS

I am currently employed as a contract and/or casual worker earning not more than $1200 per
month

I am not a part-time worker, retiree, student or self-employed

I will keep UCCW informed immediately of any changes to my employment status or personal
particulars that affect my membership status or benefits and I understand that UCCW
reserves the right to terminate my membership should there be any discrepancy in the
information declared

I will allow UCCW to use my contact details indicated here where expedient and necessary.
GROUP TERM LIFE (GTL)
I authorize NTUC Unit for Contract & Casual Workers (UCCW) to collect from me $12 for the
issuance of a benefit card with insurance coverage for a period of one year.
________________________________
Signature of Applicant
_____________________
Date