Any changes or updates must be communicated in writing to the PA HQ (Lifeskills & Lifestyle Division) and CC / RC.
Company / Business / Certificate of Registration for Companies / Business / Company / Business
Contact Person
Name: / Registration No: / Name:
(*Dr/Mr/Mrs/Mdm/Ms)
*NRIC No / FIN No:
Date of Birth
Type of Business: *Registered Sole Proprietorship / Registered Partnership / Limited Liability Partnership / Private Limited Company / Public Company / Expiry Date: / Designation:
Date of Set Up: / Paid Up Capital: / Home Tel:
Mailing Address:
Website Address (if applicable): / Authorised Capital: / Office Tel:
Office Fax:
Handphone No:
Email:
Brief Write-Up of Company (Please use not more than 150 Words):
- Brief listing & description of principal businesses / services
- Key strengths, awards and certifications that the company has received
- Registrations, memberships, associations and affiliations with government bodies and private organisations locally and internationally
______
Brief Write-Up of Company (To be typewritten)
B PARTICULARS OF PROPRIETOR / PARTNERS / DIRECTORS
Please include particulars of all partners and directors in the company. Use a separate photocopy sheet if necessary
Any changes or updates must be communicated in writing to the PA HQ (Lifeskills & Lifestyle Division) and CC / RC.
No / Name (*Dr/Mr/Mrs/Mdm/Ms)
Designation / NRIC No /
FIN No (& Expiry Date) / Date of Birth / Mailing
Home Address / Contact Numbers
1) / Office Tel / Fax:
Home No:
Handphone No:
Email:
2) / Office Tel / Fax:
Home No:
Handphone No:
Email:
3) / Office Tel / Fax:
Home No:
Handphone No:
Email:
4) / Office Tel / Fax:
Home No:
Handphone No:
Email:
5) / Office Tel / Fax:
Home No:
Handphone No:
Email:
6) / Office Tel / Fax:
Home No:
Handphone No:
Email:
7) / Office Tel / Fax:
Home No:
Handphone No:
Email:
C COURSES / PROGRAMMES TO BE OFFERED AT CCs / RCs
AND PAST TRACK RECORD OF OFFERING SUCH COURSES
Title of Course / Programmeto be Offered
Details to be provided in Annex A
of this form / Track Record of Training Provider
Please state customers and locations (including address and contact numbers) where course / programme is being offered or had been offered by training provider. Please also include customers' references, where possible. (eg. letters; names and contact numbers of customers for CC / RC to call on) / Duration of Services Provided
Example:
- Japanese Language Course /Example:
- Ang Mo Kio Zone ‘3’ RC Centre, Block 55,AngMoKio Ave 4, RC Chairman,
Mr Wong Sin Tze, tel: 63339640
(Copy of Reference letter from RC Chairman
attached)
- Bank of America, #03-00, Bank of America
Building, Shenton Way, Human Resource
Director, Ms Lim Tai Tai, tel: 63449888
(No reference letter available) /
Example:
- 2000 to 2002- 1999 to 2003
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
DMEDICAL & PERSONAL DECLARATION
Please tick the appropriate box
(The information declared will not automatically disqualify applicants from being shortlisted)
1)Is any of the proprietors, partners, company directors, office bearers or trainers Yes Noa member of any of the People’s Association’s Grassroots Organisations?
2a)Do any of the proprietors, partners, company directors, office bearers or trainers have Yes No
any criminal record1 in Singapore?
2b)Do any of the proprietors, partners, company directors, office bearers or trainers have Yes No
ever been charged or convicted in a court of law in any other country?
3)Has any of your trainers ever suffered, or is suffering from any medical history of Yes No
pulmonary, nervous or mental health conditions, prolonged ill health, or impediment in
speech or hearing or any physical impairment or such other contagious or potentially
contagious disease not herein stated?(If yes, please submit Certification By Examining
Doctor that the trainer is free from the stated illness or disease and is fit for employment)
4) Has any of your trainers ever been suspended, discharged or dismissed from the Yes No
services of any employer?
If your answer is "Yes” to any of the above, please provide brief factual information and documents(where relevant)
1- By this, we refer only to a criminal record of a conviction under the Registration of Criminal Act
E DECLARATION
On behalf of my company / business, I hereby declare that all information provided is true and correct; and agree to abide and be bound by the Terms and Conditions of the PA, Community Club Management Committees, other PA Committees and Organisations; and authorise the PA to disclose my / my company’s information to its employees, service providers, vendors and affiliated partners. I understand that if I have suppressed any material fact or given false information, the PA shall have the right to terminate my company's services as a Training Provider at any of the CCs / RC Centres and to delist my company’s name and other companies or entities which I may have a direct or indirect interest from the PA’s pre-qualified list of training providers, which will bar my company and other companies or entities which I may have a direct or indirect interest in from providing courses / programmes at CCs and RC Centres, without prejudice to any of their other rights for damages and/or losses and/or indemnities against my company and other companies or entities which I may have a direct or indirect interest for breach of contract or failure to fulfil the full term of their contract as a result of the termination. I understand that the PA will assess my application based on performance and track records of my company / business and the trainers conducting the course(s), demand for the course(s), supply and standards of training providers in the market, and other criteria; and the PA has no obligation to disclose the reasons to me or my company under any or any circumstance.
I am also fully aware and accept that I and my partner(s) / director(s) / trainer(s) would be, from time-to-time, subject to the necessary audits by the relevant government and / or investigative authorities and / or appointed agencies under the normal procedures and policies of the PA and / or the Singapore Civil Service and my partner(s) / director(s) / trainer(s) are fully aware and undertake to comply fully with such necessary audits and acknowledge that any failure to render assistance in or to clear such audit would be tantamount to my company breaching the terms of engagement and PA shall have the right to immediately terminate my company's services as a Training Provider at any of the CCs / RC Centres and to delist my company’s name and other companies or entities which I may have a direct or indirect interest from the PA’s pre-qualified list of training providers, which will bar my company and other companies or entities which I may have a direct or indirect interest in from providing courses / programmes at CCs and RC Centres, again without prejudice to any of their other rights for damages and/or losses and/or indemnities against my company and other companies or entities which I may have a direct or indirect interest for the breach of contract or failure to fulfil the full term of their contract as a result of the termination.
Further, I also fully understand and accept that my company’s services may be required to commence or continue before the information (and / or any updates) provided are fully verified by the PA, which may eventually prove adverse and / or unfavourable to me / my company, and / or that the result(s) of such audits carried out from time-to-time may prove adverse. In such an event or circumstance(s), I fully agree and accept that the PA shall be fully entitled at its sole discretion to terminate the provision of teaching and / or instructional services with immediate effect
For EmploymentPass or DependentPass Holders Only
The training provider will duly and promptly inform the CC / RC of any trainer whose pass is cancelled / rejected for renewal and to ensure that trainers have valid employment or dependent passes at all times and the approval of the relevant government agencies to provide training for PA. The trainers' provision of services at the PA will be subject to the validity of their employment or dependant passes and the approval of the relevant government agencies to provide training for PA.
Name & Designation Signature
Authorised Company Stamp Date
OFFICIAL USE
Application Form Received on: / Application ID No.:Annex
COURSE PROPOSAL FORM
Note: Please use a fresh form for each course to be offered.
Applications will not be considered or will be delayed if a proper typewritten course proposal is not provided.
PROPOSED COURSE DETAILSCourse Title / Medium of Instruction / Target Group
(please state age range for children's courses)
No. of Session(s) / No. of Hour(s) per Session / No. of Participants per Class
Minimum / Maximum
Brief Description of Course
(please use not more than 200 words. The information will be used for publicity and marketing purposes)
- Background and history of the subject
- Course Content / Syllabus (please provide separate attachments if necessary)
- Teaching Methods
- Materials to be purchased / given
Aikidois a modern, non-violent and non-competitive Japanesemartial art of self-defense. Besides being a means of work-out and character development, Aikido also emphasises proper etiquette, self-discipline and a spirit of respect for fellow human beings.
There will be a 15-minute warm-up at the beginning of each training session. After the warm-up, the Trainer will demonstrate basic Aikido techniques and student will then partner each other to practise. After some basics, the Trainer may split the class up into the different grades to train related techniques. Towards the end of the class, throw exercises are done in groups for students to practise falling and experience a variety of training partners. Sometimes, free throw exercises are also done to train student’s reaction when being attacked by one or even more attackers. At the end of the class, a breathing extension exercise is usually done in a seating position with a partner.
All-white training jacket and pants with belt is the basic attire for Aikido. As beginners progress, they will change from white belt to various coloured belts to indicate their grades.
Sample Course Proposal 2
Pilates is a method of exercise developed by German-born Joseph Pilates in the 1920s, which consists of various physical movement programs designed to stretch, strengthen, and balance the body. It is a low-impact exercise which focuses on postural symmetry, breath control, abdominal strength, spine, pelvis and shoulder stabilization, muscular flexibility, joint mobility and strengthening through the complete range of motion of all joints.
A typical 1-hour mat work training session starts with fundamental movements like breathing and gentle spine exercises to warm up the body. This is followed by 40 minutes of mat work movements and finally 5 to 10 minutes of relaxation (warm down) to end the class. The trainer will demonstrate and explain each movement and move among the participants to ensure proper technique and assist as necessary.
While practising Pilates, you will require:
(i) A folded towel, blanket or exercise mat of adequate thickness and density to place on the floor for protection of your spine;
(ii) A long towel or stretchy rubber exercise band; and
(iii) A flat cushion or small folded towel to place under your head, if necessary.
Course Proposal (To be typewritten)
Course Proposal (To be typewritten)
COURSE FEE AND MATERIAL FEE
Proposed Course Fee
(inclusive of GST)
Full Course Fee
S$
Per Hour Course Fee
S$ / Other Fees: eg Material Fee
(inclusive of GST)
S$ ( )
S$ ()
S$ () / Payment Schedule by Course Participant
(e.g. For the full course, per month basis, per term basis etc).
COURSE FEE SHARING ARRANGEMENT
- The distribution of proceeds, according to the proportions shown below, will be net of Goods and Services Tax (GST) from the full
- Disbursement of the net proceeds, in respect of each course, will take place only after the successful completion, in the opinion of the
the PA or any government authority for any reason, and will be administered by the CC / RC where the course was conducted.
Period
(e.g.1 Sept 2008 to 31 Dec 2008)
/ Training Provider
(e.g. 65%)
/ CC / RC
(eg. 35%)
Name Name of Training Provider Signature & Date
1
* Delete Accordingly
ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE21March 2017