Agency for Integrated Care

CLAIM FORM FOR HMDP-ILTC FELLOWSHIP SCHEME

Please submit claim form to:

Agency For Integrated Care

ILTC People Excellence Office

No. 5 Maxwell Road

#10-00 Tower Block

MND Complex

Singapore 069110

Attn: HMDP-ILTC Secretariat

Fax No.: 6820 0728

Tel No.: 6603 6868

Email:

Application ID (refer to Letter of Award)
ILTC Institution
Name of Trainee
Programme Title
Course Duration / days / months / years
No. of Official Working Days
Advance Payment / S$
Claim Projected (refer to Letter of Award) / S$
Claim Submitted / S$
Liaison person from ILTC Institution / Name:______
Designation:______
Contact no.:______
Email address:______
Claim Submission Checklist:
(Original / Certified-True-Copies of these documents must be submitted with this claim)
/ Post-Training Report / / CPF Employer’s contribution
(If claiming locum)
/ Copy of Bond between ILTC and Trainee / / Airport Transfer Receipts
/ Tuition / Course Fees and Other Compulsory Fees / / Visa Fees Receipts
/ Itinerary and Boarding Pass / / Travel / Medical Insurance Receipts
COST (S$)
Please include detailed breakdown of the following:
Description / Approved Budget (Refer to Letter of Award) / Claim Amount / Remarks / Supporting documents
(Original or certified true copies must be submitted)
Course/Tuition fees / S$ / S$ / Invoice, Attendance / Time sheet, Certificate
Airfare (return, economy) / S$ / S$ / Itinerary, Boarding pass
Subsistence Allowance / Computed by Secretariat
Locum fees
- Please state duration.
-To include CPF (Employer’s Contribution) in this calculation / S$ / S$ / For training less than 30 days,
-Payslip of locum or
-Invoice to organisation
For training more than 30 days,
-Payslips of awardee
Airport transfers
(home-airport-hotel) / S$ / S$ / Receipt
Visa fees / S$ / S$ / Receipt
Medical insurance / S$ / S$ / Receipt
Travel insurance / S$ / S$ / Receipt
Others
(With Justification) / S$ / S$
Recommended Funding (%) / %
Total Cost
(exclude Subsistence Allowance) / S$ / S$
Declared by Trainee
Name
Designation
Signature / Date
Endorsed by ILTC Institution
Name
Designation
Signature / Date

Claim Form for HMDP-ILTC Fellowship SchemePg 1 of 2

Version: July 2012