Purpose and completion rules
This form pays work-pass administrative fees, not levy. Complete every Part 1 field with account name/number and signatures matching bank records. Do not use correction fluid/tape; the account holder signs beside changes.
Part 1: service and entity identifiers
Business EP eService uses UEN and WP Online uses CPF Submission Number. EA EP eService uses UEN; WP Online/domestic-helper/confinement-nanny service uses EA Licence Number.
Provide entity name, contact, mobile, email, bank, bank-statement account name, account number, date and bank-record signature/thumbprint. The billing organisation is MOM Work Pass Division/AG.
Debit authorisation
Authorise bank processing of MOM debits. Insufficient funds may cause rejection and charges; the bank may instead allow overdraft with charges. Authorisation continues until written bank termination or revocation received through MOM.
Parts 2–3 and rejection reasons
MOM completes Part 2’s bank and WP/EP/EA reference particulars. The bank completes Part 3. Rejection reasons include mismatched signature/thumbprint, wrong account name/number, incomplete/unclear signature, unsigned amendment or another stated reason.
Post the original and await the outcome
Post the completed original to Admin Fee & E-Payment Management, Work Pass Division, MOM, 18 Havelock Road, Singapore 059764. The outcome is emailed in four weeks, potentially longer if bank processing requires it.
Official source
Written independently from official MOM source material.