PAC-SSO-F24: Cancellation of Student’s Pass

Cancellation of Student’s Pass

PSBA-SSO-F24 R00
This form is to be completed by students requesting to cancel Student’s Pass. For online cancellation, the pass must have a minimum 5 days validity. All information given in this form must be accurate and duly completed by student.
By submitting your personal information, you expressly allow PSB Academy to contact you for Student's Pass Renewal purposes. For more information on our privacy policy, please visit psb-academy.edu.sg/pdpa*

Yes, I have read and agree.
Important:
1. Proof of Departure details (eg, flight e-ticket) must be submitted together with the student pass cancellation form.
2. Social Visit Pass (white card) will be emailed to student once ICA approved the cancellation.
3. Do note that the Student’s Pass (STP) will not be valid after the cancellation is approved.
4. Students can return their expired or cancelled cards by the following ways:
  - Send the student pass cards to ICA Building by Post:
    ICA Building, 11 Kallang Road, Singapore 208718
  - Return to Immigration checkpoint officers when departing Singapore
  - Return to any counters at ICA Building @ Level 4
Commencement Date of Course*

DayMonthYear
Date
Course Enrolled*
Full Name of Student (as per Passport)*
Student's Pass ID Number*
Student's Pass Expiry Date *

DayMonthYear
Expiry date must at least 5 days from today. You are not allow to cancel your pass with less than 5 days validity. Please visit ICA in person for the cancellation to avoid overstay.
Passport Number*
Passport Expiry Date *

DayMonthYear
Date
Email Address*
Social visit pass (white card) will be sent to this email address, please ensure it is accurately filled in.
Phone Number*

Country CodeArea CodePhone Number
Reasons for cancellation (as requested by ICA)*
Declaration
- I declare that the information given is true and accurate to the best of my knowledge and I have not willingly suppressed any information. PSB Academy will not be held responsible once the student pass is cancelled.
- I understand that ICA will take approximately 4 working days to approve the cancellation and process the Social Visit Pass (if applicable).
- I understand that I will have to return the original copy of the Student’s Pass (STP) to the ICA officer at the checkpoint when leaving Singapore.
Signature*

Clear
Are you above 18 years old?*

YesNo
Date*

DayMonthYear
Date
Declaration by Parent/Guardian of students under 18-year-old

I declare that I am the parent/guardian of the above student. I give my full consent for his/her student pass to be cancelled.
Full Name of Parent/Guardian (as per Passport)*
Phone Number*

Country CodeArea CodePhone Number
Signature*

Clear
Date*

DayMonthYear
Date
Programme Consultant
example@example.com
Document Classification: Confidential
Should be Empty:

Cancellation of Student’s Pass

Declaration by Parent/Guardian of students under 18-year-old