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Type of registration:

New registrationRe-registration
Basic Information
Name*

First NameLast Name
Email*
example@example.com
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Citizenship*
Country of origin: *
Passport Holding: *
Email
example@example.com
Phone (Mobile)*

Area CodePhone Number
Phone (Home)

Area CodePhone Number
Phone (Office)

Area CodePhone Number
Mobile (Plan-most used)
Mobile (Service Provider)
Highest level of education

Primary (PSLE)Secondary (O' Level)JC (A' Level)Polytechnic (Diploma)University (Bachelors degree)Post graduate degree
Employment Status:

UnemployedHome-makerIn-between jobsWork part-timeWork freelanceSelf-employedEmployed full timeBusiness Owner
Job Title:
Job Industry:
Last employed industry:
Month & year of last employment:
Monthly Household Income

Below SG$ 3,000SG$ 3,000 - SG$ 4,999SG$ 5,000 - SG$ 6,999SG$ 7,000 - SG$ 8,999SG$ 9,000 - SG$ 10,999SG$ 11,000 and above
Marital Status

SingleEngagedMarriedDivorcedWidowedPartner
Number of children

0123456
How old is your kid?
How old is your 1st kid?
How old is your 2nd kid?
How old is your 3rd kid?
How old is your 4th kid?
How old is your 5th kid?
How old is your 6th kid?
Topics you like to discuss:

Arts & EntertainmentAutos & VehiclesBeauty & FitnessBooks & LiteratureBusiness & IndustrialComputers & ElectronicsFinanceFood & DrinkGamesHobbies & LeisureHome & GardenInternet & TelecomJobs & EducationLaw & GovernmentNewsOnline CommunitiesPeople & SocietyPets & AnimalsReal EstateReferenceScienceShoppingSportsTravelWorld Localities
Banking & Financial Planning:
Banks used:

POSB/DBSUOBOCBCCitibankStandard ChartedMaybankBank of ChinaHSBCCIMBOthers
Please specify:
Do you have the following?

Debit CardCredit CardPrivilege BankingMortgage loanInsuranceBondsStocksSharesEquitiesOthers
Please specify:
Property:
Do you own a house?

YesNoWaiting for keys
Type of housing owned:

HDB 2 Room and belowHDB 3 RoomHDB 4 RoomHDB 5 RoomHDB Jumbo FlatHUDCECCondominiumPrivate ApartmentTerraceBungalowOthers
Type of housing currently living in:

HDB 2 Room and belowHDB 3 RoomHDB 4 RoomHDB 5 RoomHDB Jumbo FlatHUDCECCondominiumPrivate ApartmentTerraceBungalowOthers
Please specify:
Do you own a private vehicle?

YesNo
What vehicle do you own?

CarMotor-bike
Please specify vehicle make and model owned:
Technology use:
Gadgets owned:

SmartphoneLaptopPC ComputerTabletWearable Tech
Internet service provider:

SingtelM1StarhubMyRepublicViewquestCircles lifeOthers
Please specify:
Paid TV content subscription:

Mio TVStarhub TVNetflixViuuDailymotion
Paid music content subscriptions

Spotify PremiumApple MusicDeezer +
Do you shop online?

YesNo
What platforms do you use for online shopping?

TaobaoQoo10AmazonLazadaEzBuyhonestbeeBook DepositoryCarousellZaloraiHerbRedmartSheng ShiongOthers
Please specify:
Lifestyle habits:
Do you smoke?

NoQuit recentlySocial smokerHabitual smoker
Type of cigarettes:

Original/RedMentholFlavouredE-cigarettesCigarsOthers
Do you drink alcohol?

NoUsed toSociallyHabitual/regular drinker
Types of Alcohol:

BeerSpiritsWineWhiskyOthers
Health & wellness:
Do you have any known medical conditions?

YesNo
Type of medical conditions currently suffering from:

AllergiesDiabetesHeart DiseaseBlood pressureCancerAsthmaVision ImpairmentHearing ImpairmentStrokeHIV/AIDSOthers not mentioned in this list
Please specify:
Do you own any Health Insurance?

YesNo
Please specify what is the health insurance you currently owned?
E.g. Insurance Company, Plan type
How did you hear about us?

FriendGoogle searchOther internet searchColleague referralEmailOthers
Which type of survey format is preferred?

Face to FaceOnlineVideo Conferencing via Zoom or Google Meets or similar (requires use of PC or Laptop with stable internet)
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Basic Information

Banking & Financial Planning:

Property:

Technology use:

Lifestyle habits:

Health & wellness: