CENTRE-BASED FINANCIAL ASSISTANCE SCHEME FOR CHILD CARE ANNEX 9A

APPLICATION FORM Revised as at May 2009

This form may take the parent approximately 15 minutes to complete. The documents which the parent may need to refer to are listed
below (see supporting documents to be submitted).
ELIGIBILITY CRITERIA
To apply for CFAC, the child must fulfil the following eligibility criteria:

The child is a Singapore citizen. If the child is a permanent resident of Singapore (PR), at least one immediate family member (parent or
sibling) is a Singapore citizen.

The child is below 7 years old and attends a licensed child care centre.

The family’s monthly household income is $1,800 or lower.

The child’s mother must be working.

CHECKLIST OF SUPPORTING DOCUMENTS

All applications must be accompanied by the relevant supporting documents. Tick  the documents that have been attached to this
application. An application will not be processed by the CDC unless all the required supporting documents are attached. Incomplete
applications will also be returned to the child care centre.

General –

 Copy of child’s Birth Certificate (BC).

 Copy of both parents’ updated NRIC. If the child is cared for by a guardian, then submit a copy of the proof of guardianship and the
guardian’s NRIC.
 Copy of other sibling’s BC and NRIC of household (HH) members staying together (Only applicable for appeal cases where the
monthly household income exceeds $1800 .)

Income Statement (one of the following documents)

 Latest copy of both parents’ pay slips, or

 Letter from employer stating both parents’ monthly income, or
 “Certification of Employment and Income by Employer ” template (Annex 9F) duly completed and signed by both parents’
employers (can be submitted as a substitute for letter from employer), or
 Copy of latest CPF statements of both parents.
 Where overtime pay / allowances / incentives are reflected on the pay slip, please submit the past 3 months’ pay slips, in order to
ascertain if these components are received on a regular basis. However, if the past 3 months’ pay slips are not available and these
components are not received on a monthly basis, parent is to complete the “Declaration” template (Annex 9E) and attach the latest
Income Tax statement.

 For a parent who is self-employed, the parent has to complete the “Declaration” template (Annex 9E) and attach a copy of the
business licence (if running a business) or similar document.

 For a mother who is engaged in home-based work and qualified for government child care subsidy, the mother should
submit proof that she works a minimum of 56 hours per month. Documents such as vouchers showing payments or letter
to certify services rendered etc. can be accepted. As a last resort, if no documentary proof is available, mother should complete and
submit the “Declaration” template (Annex 9E).

 For a mother who is unemployed owing to medical reasons and needs child care in the best interest of her child, she should
submit a valid medical certificate (MC), specifying her medical condition and the period which she is unfit for work.

 For a mother who is unemployed but in the process of looking for employment, she should complete Annex 9H and submit proof of
job search e.g. letter or notification showing she is seeking job placement or other employment services (e.g. from a Singapore
Workforce Development Agency Distributed CareerLink Network (DCN) centre or a private employment agency).

 For a mother who is unemployed but undergoing training, she should submit a document which verifies that she is attending,
or has been accepted to attend, a training programme. The document should also state the duration of the training programme.

 For a father who is unemployed, he is to complete the “Declaration” template (Annex 9E) and provide his latest CPF statement
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 Other supporting documents, where applicable e.g.
 Copy of parent’s certificate of death or divorce documents and court order pertaining to maintenance claims and custody of child(ren).
 Copy of custody or guardianship papers. If such documents are not available, the guardian can make a declaration of the
guardianship status using the template in Annex 9E.
 Notice from the Prison or Drug Rehabilitation Centre e.g. a copy of the Prison Visiting Order.
 Letter or social report from social worker of a social service agency (e.g. Family Service Centre) or MCYS officer.
 Copy of Maintenance Order. If the Order is not available, or the actual amount received is different from that stated in the Order,
the parent is to make a declaration of this, using the template in Annex 9E.
 Others (specify) _____________________________________________________________________________________

PART I: CHILD’S PARTICULARS

Name Household
Size1
(including
applicant)

Birth Order
(e.g. first child)

BC. No. Date of Birth (dd/mm/yyyy)

Nationality Singapore Citizen Gender F Race Chinese Indian Others

Singapore PR M Malay Eurasian (specify)______
Type of Accommodation:
Address (of child) HDB 1-rm Institution
HDB 2-rm Others
HDB 3-rm
HDB 4-rm Accommodation Status:
HDB 5-rm Rented
Housing
HDB Exec Purchased
HUDC Living with relatives
Private Flat Others (specify)
Private House
Shop house ___________________
Homeless

1
Household size refers to the total number of family members living in the same household
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PART II: PARENTS’ / GUARDIAN’S PARTICULARS

MOTHER / GUARDIAN* (delete accordingly) FATHER / GUARDIAN* (delete accordingly)

Name Name

NRIC No. NRIC No.

Date of Birth Date of Birth

No religion No religion
Buddhism Islam Christianity Buddhism Islam Christianity
Religion Religion
Chinese Hinduism Others Chinese Hinduism Others
Traditional Sikhism (Specify) ____ Traditional Sikhism (Specify) ____
Beliefs/Taoism Beliefs/Taoism

Chinese Indian Others Chinese Indian Others

Race Race
Malay Eurasian (Specify) ____ Malay Eurasian (Specify) ____

Singapore Citizen Singapore Citizen

Nationality Singapore PR Nationality Singapore PR
Foreigner (Specify) ________________ Foreigner (Specify) _________________

Gender Male Female Gender Male Female

MOTHER / GUARDIAN* (delete accordingly) FATHER / GUARDIAN* (delete accordingly)

Marital Widowed Widowed

Single Single
Status Divorced Marital Status Divorced
Married Married
Separated Separated

No Formal O Level No Formal O Level

Qualification A Level Qualification A Level
Pre school Diploma Pre school Diploma
Primary ITE / Vocational Primary ITE / Vocational
Highest Highest
PSLE Degree PSLE Degree
Educational Educational
Lower Secondary Post Graduate Lower Secondary Post Graduate
Level Level
(Sec 1-3) Special School (Sec 1-3) Special School
Upper Secondary Professional Upper Secondary Professional
(Sec 4-5) Qualification (Sec 4-5) Qualification
N Level N Level

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 Employment Status Employment Status

Employed Full time (working at least 56 hours per month) Employed Full time
Employed Part time (working at least 56 hours per month) Employed Part time
Looking for a job Looking for a job
Training for a job Training for a job
Unemployed* Unemployed
Medically unfit for work (≤ 3 months) Medically unfit for work (≤ 3 months)
Medically unfit for work (> 3 months) Medically unfit for work (> 3 months)
Retired Retired
Schooling (i.e. student) Schooling (i.e. student)
* This includes a mother who works less than 56 hours per month.

If employed, complete this section: If employed, complete this section:

Occupation Occupation

Name & Address of Employer Name & Address of Employer

Start Date (mm/yyyy) Start Date (mm/yyyy)

Net Monthly Income2 $ Net Monthly Income $

Address (if different from child’s address) Address (if different from child’s address)

Number of Children in the family (including the child applying for CFAC assistance):

1 child 2 children 3 children 4 children 5 children 6 children and above

2
Net monthly income excludes the contribution to CPF and other allowances (e.g. shift, uniform, meal, transport allowance) that the parent does not receive on a
regular basis.

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PART III: PARTICULARS OF IMMEDIATE FAMILY MEMBERS3 IN THE HOUSEHOLD (INCLUDING CHILD APPLYING FOR CFAC
ASSISTANCE)

Relationship to child
Name Age applying for CFAC Occupation
assistance

PART IV: MONTHLY HOUSEHOLD INCOME

1. Net income of child’s mother $

2. Net income of child’s father $
3. Income from rent4 (if applicable) $
4. Maintenance payment5 based on the actual amount received on a regular basis (if applicable) $
5. Monthly commission earnings6 (if applicable) $
6. Other income (Specify): $
TOTAL $

Is the family currently receiving assistance from the Community Development Council (CDC) under
Yes
No
Work Support?

If answer is ‘Yes’ and mother is unemployed but looking for work (through Work Support), the mother is not required
to submit any other document as proof of job search, to support her CFAC application. The verification will be carried
out at the CDC.

If applicant is the Guardian, highlight the circumstances leading to guardianship (e.g. child’s parents in prison, deceased etc.)

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For appeal cases where the monthly household income is above $1800, please also fill in the particulars of dependant (non-immediate)
family members in the household (i.e. living at the same address)
4
This is income from renting out a room (or rooms) of the family home or other properties.
5
If the parent does not receive the maintenance payments on a regular basis, the amount does not need to be included. However, the parent
needs to submit a declaration.
6
The monthly commission earnings can be based on the average of commission earned over the past 3 months.
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PART V: PARENT’S / GUARDIAN’S DECLARATION

I, the undersigned, declare that all the above is true and correct. I understand that providing any false information is an offence
under the Penal Code (Chapter 224), and that if I provide any false information, I am liable to be prosecuted to the full extent of the law. I
further understand that if I furnish any false information, the Government will recover from me all monies paid to me under the Centre-Based
Financial Assistance Scheme for Child Care.

I acknowledge that for the purposes of facilitating my application for financial assistance from your organisation, any and all
agencies that have any of my and/ or my household’s record may share the relevant information with you, if it is relevant to your work with me
and/or my household. I also acknowledge that the information which I and/ or the members of my household provide may be shared with any
agency or person authorised by the Ministry of Community Development, Youth and Sports (MCYS), People's Association (PA), Community
Development Councils (CDCs) and the Singapore Workforce Development Agency (WDA) for the purposes of rendering me, or assessing
my eligibility for financial or other assistance; for research in which my household members and I, as specific individuals, will not be identified;
or for any other purposes prescribed or permitted under Singapore Law. I also hereby confirm that my household members are aware of and
have agreed to these terms.

____________________________________ _____________________________ ____________________________

Name of Parent/Guardian Signature Date

SECTION VI: START-UP GRANT (To be completed by the child care operator)

Note: To apply for Start-up Grant, the child must be newly enrolled in a child care centre and has never benefited from the Grant.

Date of admission into child care centre __________________________________ (dd/mm/yyyy)

Has this child previously received the Start-up Grant at other child care centres? Yes No

If yes, state the name of the child care centre and years attended and period of enrolment _______________________________________

_______________________________________________________________________________________________________________

Details of Start-up Grant (Capped at $1,000)

1. Registration fee $
2. Deposit (equal to one month’s fee) $
3. First month’s fee (less government child care subsidy) $
4. School uniform $
5. Insurance $
6. Education materials $
7. Mattress / Mattress cover $

TOTAL $

SECTION VII: CHILD CARE CENTRE PARTICULARS (To be completed by the child care operator)
Government Child Care
Type of Centre Monthly Child Care Fee Type of Child Care Service
Subsidy

Full Day
Private $ 150 Before government subsidy
Half Day
NTUC $ 300 (including GST, if applicable).
Flexible care
Other VWO Other amount $ ________
(Total hrs/week_________)
Workplace None $______________ per month

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Name of Child Care Centre

________________________________________________________________________________________________________

Address_________________________________________________________________________________________________

_________________________________________________________________________________________________

Telephone No. _______________________________________ Fax _______________________________________________

Contact Person _____________________________ Email _______________________________________________________

Bank Details:

Cheque payable to/cheque payee ____________________________________________________________________________

Bank Name _______________________________________________ Account No.____________________________________

Address (in bank account) __________________________________________________________________________________

Acknowledgement by Child Care Operator (To be completed by the Supervisor of the Child Care Centre)

I certify that the information provided by my child care centre is correct. I also hereby acknowledge the refund policy for CFAC and Start-up
Grant (as stated below), for compliance by my child care centre:

a. If a child withdraws from the child care centre before the assistance period expires, the remaining CFAC subsidy and the deposit
component of the Start-up Grant (received by the child care centre), should be refunded to the CDC which disbursed the subsidy
and the Start-up Grant.

b. A child must attend at least one day of child care in order to be eligible for CFAC subsidy for the month.7If the child does not attend
at least one day of child care that month (without providing a valid MC for the absence), the child will not be eligible for any CFAC
subsidy for that month. The subsidy should be refunded to the CDC.

c. When a K2 child graduates from the child care centre to attend Primary 1, the deposit component of the Start-up Grant and any
CFAC subsidy which may not be claimed, should be refunded to the CDC.

No part of the CFAC subsidy or Start-up Grant, which had been disbursed by the CDC, should be returned to the family. Neither can they be
used to offset any fee arrears incurred arising from non-payment of fees by the family.

__________________________________
_____________________________ _____________________________
Name of Supervisor
Signature Date

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This is aligned to eligibility for government child care subsidy, where payment of subsidy will be terminated for the month for which the
infant/child does not attend the centre for a minimum of one day.
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