To be completed by Parent / Guardian*
Name of Child : _______________________________
BC/FIN/Passport No.*: _______________________________
Contact No. : _______________________________
Ministry of Education
SINGAPORE
PROXY FORM
This form may take you 5 minutes to complete. Please take note of the following points when you fill in the form.
Important Notes:
1) The appointed proxy must be aged 21 and above.
2) The appointed proxy should bring the completed Proxy Form and supporting documents to the child’s
school. The supporting documents are:
• A photocopy of both parents’/guardian’s NRIC/FIN (both sides)/ Passport
• A photocopy of the Birth Certificate/Passport of the child
• A photocopy of the proxy’s NRIC/FIN (both sides)/ Passport
The appointed proxy must produce their original NRIC/FIN/Passport at the school when requested.
To: Principal of _____________________________________________________ (Name of School)
I, parent/guardian* of ________________________________________________ (Name of Child),
_______________________ (BC/FIN/Passport No.*), would like to appoint Mr/Mrs/Mdm/Miss*
___________________________________ (Name of Proxy), ______________ (NRIC/FIN/Passport
No.) to:
Tick where
Appropriate
1 Submit DSA-Sec Application Form
2 Submit DSA-Sec School Preference Form
Collect S1 Option Form/ PSLE results slip/ PSLE certificate and other relevant
3
documents
4 Submit S1 Option Form
5 Collect/ submit school forms for Secondary 1 admission
By appointing the proxy, I have authorised the person to act on my behalf without any reservations. I will
bear full responsibility if the proxy fails to perform any of the above as authorised by me.
I also understand that, by authorising the proxy to complete and submit the DSA-Sec Application Form/
DSA-Sec School Preference Form/ S1 Option Form*, any choices made by the proxy would be officially
binding.
______________________________ _________________ _______________
Name of Parent/Guardian* Signature Date
NRIC/FIN/Passport No.*: ______________________
* Delete where appropriate