Mosque Planning Office

Majlis Ugama Islam Singapura (Islamic Religious Council of Singapore) Singapore Islamic Hub (SIH), 273 Braddell Road, Singapore 579702, Tel: 62568188, Fax: 62523235, http://www.muis.gov.sg

Application is open to all Muslim Singapore Citizens & PRs who are at least 21 years old.
Please complete the form in BLOCK LETTERS. For items which are not applicable, please state "NA". Where there is an asterisk (*), please delete accordingly.
Please attach a recent photograph here

Please state name of Mosque Sila nyatakan nama Masjid

Please tick the appropriate box for your application Mosque Management Board Lembaga Pentadbir Masjid (LPM)

Sila tandakan di kotak permohonan anda Islamic Missionary Committee Jawatankuasa Haiah Dakwah (JHD)

Mosque Building Committee Jawatankuasa Pembinaan Masjid (JPM)

NRIC No Name (as in NRIC) Salutation Others (specify): Race Malay

Type

Nationality Singapore Citizen

Marital Status Single

Indian

Singapore Permanent Resident

Married

Chinese

Widowed

Others (specify): Country of Birth Sex Male Home Address Block / Hse No. Unit No. Female Date of Birth (DD / MM / YYYY) / /

Divorced / Separated Age

1 9

Street / Bldg Name

Postal Code Contact Information Home Office Ext

Handphone

Office Fax

Email

Occupation

Name of Employer / Company / School Address of Office / Company / School Block / No. Unit No.

Street / Bldg Name

Postal Code

Mosque Planning Office

Majlis Ugama Islam Singapura (Islamic Religious Council of Singapore) Singapore Islamic Hub (SIH), 273 Braddell Road, Singapore 579702, Tel: 62568188, Fax: 62523235, http://www.muis.gov.sg

Please provide a brief description of your job

Current Monthly Gross Personal Income (Before CPF deduction) $1,000 & below $1,001 to $2,000 $2,001 to $3,000 $3,001 to $4,000 $4,000 to $5,000 Above $5,000

Membership in Committee CCC, CCMC, YEC, SCEC, RC, CDC, MAEC, any Muslim Associations, Political Parties, Professional Institutions Start Date DD/MM/YY End Date DD/MM/YY

Committee / Organisation

Position Held

Accomplishments (if any)

Title of Award received, year awarded and organisation (if any, PBS,PBM,BBM & etc)

Educational Qualifications Name of Institution From (Yr) To (Yr) Highest Qualification Attained (specify clearly)

Language Proficiency English Malay Tamil Mandarin Arabic Others (specify)

NS Status NSF (Full-time)

Employment Status Employed (Full-time)

Emplyment Sector (if applicable) Civil Service

NS Man (Reservist)

Employed (Part-time)

Statutory Board

NS Reserve

Self-Employed

Govt-owned company

Not Applicable

Retired

SPF, SAF, SCDF

Others (specify)

Unemployed

Private Sector

NTUC / Union organisation

Others (specify)

Mosque Planning Office

Majlis Ugama Islam Singapura (Islamic Religious Council of Singapore) Singapore Islamic Hub (SIH), 273 Braddell Road, Singapore 579702, Tel: 62568188, Fax: 62523235, http://www.muis.gov.sg

Type of Dwelling HDB 1-room HDB 4-room HUDC Condominium / Private Apt

HDB 2-room

HDB 5-room

Shop with dwelling unit

Others (specify)

HDB 3-room

HDB EA / Maisonette / Jumbo

Landed property

The following family member(s) (related by blood or marriage) is / are currently working / serving / applying for a position in the MMB: No Name 1 2 3 4 5 6 7 8 9 10 Name of Mosque Relationship

IMPORTANT
FOR NEW APPLICANTS ONLY Areas of Interest or Special Skills that you wish to contribute in, if appointed

FOR CURRENT MMB MEMBERS ONLY Please state your accomplishmen(s) while serving in the MMB and the area(s) of improvement you wish to further enhance, if re-appointed

Name of Introducer Address of Introducer

Years Known

Signature of Introducer

Date

Mosque Planning Office

Majlis Ugama Islam Singapura (Islamic Religious Council of Singapore) Singapore Islamic Hub (SIH), 273 Braddell Road, Singapore 579702, Tel: 62568188, Fax: 62523235, http://www.muis.gov.sg

APPLICATION FORM IMPORTANT Declaration by Applicant 1 I accept and will abide by the latest Muis Management of MMB / MBC / IMC Regulations and other additional rules and regulations issued from time to time by Muis. 2 I accept Muis' decision to place my service at any mosque and position deemed suitable by Muis. I accept all decisions made by Muis and the authorities as final regarding my appointment, position in MMB / MBC / IMC and any principles concerning the management of MMB / IMB / IMC. 3 If appointed, I will discharge my duties faithfully and will strive to the best of my ability to assist, uphold and support the vision and mission of MMB / MBC / IMC / Muis on all matters for the benefit of the Muslim community, lslam and the nation.

BORANG PERMOHONAN PERIHAL PENTING Pengakuan Pemohon 1 Saya menerima dan akan mematuhi Peraturan Pengurusan LPM / JPM / JHD oleh Muis yang terkini, dan semua syarat dan peraturan tambahan yang dikeluarkan dari masa ke semasa oleh Muis. 2 Saya menerima keputusan Muis untuk menyalurkan saya ke sebarang masjid dan jawatan yang difikirkan sesuai. Saya juga akan menerima semua keputusan Muis dan pihak berkuasa sebagai muktamad berhubung dengan perlantikan saya, jawatan dalam LPM / JPM / JHD dan sebarang dasar atau perihal 3 Jika dilantik, saya akan menunaikan tanggungjawab dengan amanah dan akan berusaha sedaya upaya untuk membantu, mendokong dan menyokong visi dan misi LPM / JPM / JHD dan Muis dalam semua perkara yang bemanfaat bagi Islam, masyarakat dan negara. 4 Saya bersedia mengikuti sebarang program latihan dan pembangunan yang diatur Masjid dan Muis melalui Pejabat Perancangan Masjid.

4 I am ready to attend any training and development programmes arranged by the Mosque and Muis through it's Mosque Planning Office.

5 I agree that if any problems occur in the course of my duty as a member of the MMB / MBC / IMC, it must be resolved amicably, with due respect and in the of brotherhood within MMB / MBC / IMC meetings. In the event that there are no solutions for issues or problems encountered it will be referred to Muis for advice and I will accept Muis' decisions as final.

5 Saya akur jika berlaku sebarang masalah semasa menjalankan tugas sebagai anggota LPM / JPM / JHD, ia mesti diselesaikan dengan cara baik, penuh hormat dan semangat persaudaraan lslam dalam mesyuarat LPM / JPM / JHD. Jika tiada jalan penyelesaian dalam isu atau masalah yang dihadapi, ia akan dirujuk kepada Muis untuk mendapatkan nasihat dan panduan. Saya menerima keputusan Muis sebagai muktamad. 6 Saya tidak pernah dihukum atas sebarang kesalahan jenayah dan juga bukan seorang muflis. Jika ada, butir- butirnya seperti berikut (nyatakan bila dan atas kesalahan apa) :

6 I have never been prosecuted for any criminal offence and am also not a bankrupt. If any, the details are as follows (please state when and for what offence) :

7 I am not currently a staff of any mosque and I will update Muis if I am employed by a mosque.

7 Saya tidak bekerja di masjid, dan akan memaklumkan Muis jika saya mula bekerja di masjid.

I have read and fully understood the contents of the declaration, and terms and conditions for application. I heareby declare that all the information given by me in this form are true and correct at time of submission. Saya telah membaca dengan teliti dan faham isi kandungan pengakuan dan syarat-syarat permohonan. Saya mengaku bahawa segala keterangan yang saya berikan adalah benar dan betul pada masa permohonan.

Name of Applicant Nama Pemohon

Date Tarikh

Signature Tandatangan