Miss
13-5-30
OGEM
OGEM
Submission of Online Indemnity Form
Academic Year : 2013 Semester : 1 Programme Name : GEM Discoverer Placement / Host University : KOREA UNIVERSITY Host Country : South Korea
A) PERSONAL PARTICULARS 1. 2. 3. 4. 5. Full Name: SHENG LU Gender: F NTU Matriculation Number: U1220499G NRIC / FID: G1030432L Passport Number: G43795542 Passport Expiry Date: 25-JUL-2020 6. Nationality: Chinese (B) PROGRAMME DETAILS 1. Name of Host University: KOREA UNIVERSITY 2. Country of Host University: South Korea 3. Official Duration of Overseas Exchange: From : 29-JUN-2013 To : 10-AUG-2013 4. Housing. Will you be staying on campus at the Host University? Yes (C) HEALTH AND TRAVEL INSURANCE POLICY DETAILS 1. Name of Insurer: Ping An 2. Type of Policy: Ping An Oversea Insurance Policy 3. Policy Number: 10827001900100352582 4. Start and End Dates of Policy (ensure you are covered on all days while you are overseas): From : 25-JUN-2013 To : 24-AUG-2013 5. Insurer Hotline Number (in the event of emergencies): +8695511 7. Date of Birth: 28-AUG-1992 8. Home Contact Number:8613904315060 9. Mobile Contact Number: 85565661 10. NTU Email Address: SHEN0116@ntu.edu.sg 11. Alternate Email Address: shengluyea@gmail.com
The 1st emergency contact fields are mandatory whereas 2nd emergency contact fields are optional. 1st EMERGENCY CONTACT Name: Sheng Chongwei Relationship to Applicant: father Address: dongchaoyang road changchun jilin province china Contact Number: +86043188960375 (Home) +8613904319033 (Office) +8613904315060 (Handphone) 2nd EMERGENCY CONTACT Name: Zhou Jie Relationship to Applicant: mother Address: shenjiting yatai street panshi road changchun jilin province china Contact Number: +86043185265667 (Home) +86043185265027 (Office) +8613944862473 (Handphone)
(D) DECLARATION 1. I hereby declare that I have taken up this Overseas Programme of my own accord. 2. I agree to assume any and all risks which might be associated with this Overseas Programme and
OGEM
OGEM
Submission of Online Indemnity Form
Academic Year : 2013 Semester : 1 Programme Name : GEM Discoverer Placement / Host University : KOREA UNIVERSITY Host Country : South Korea
A) PERSONAL PARTICULARS 1. 2. 3. 4. 5. Full Name: SHENG LU Gender: F NTU Matriculation Number: U1220499G NRIC / FID: G1030432L Passport Number: G43795542 Passport Expiry Date: 25-JUL-2020 6. Nationality: Chinese (B) PROGRAMME DETAILS 1. Name of Host University: KOREA UNIVERSITY 2. Country of Host University: South Korea 3. Official Duration of Overseas Exchange: From : 29-JUN-2013 To : 10-AUG-2013 4. Housing. Will you be staying on campus at the Host University? Yes (C) HEALTH AND TRAVEL INSURANCE POLICY DETAILS 1. Name of Insurer: Ping An 2. Type of Policy: Ping An Oversea Insurance Policy 3. Policy Number: 10827001900100352582 4. Start and End Dates of Policy (ensure you are covered on all days while you are overseas): From : 25-JUN-2013 To : 24-AUG-2013 5. Insurer Hotline Number (in the event of emergencies): +8695511 7. Date of Birth: 28-AUG-1992 8. Home Contact Number:8613904315060 9. Mobile Contact Number: 85565661 10. NTU Email Address: SHEN0116@ntu.edu.sg 11. Alternate Email Address: shengluyea@gmail.com
The 1st emergency contact fields are mandatory whereas 2nd emergency contact fields are optional. 1st EMERGENCY CONTACT Name: Sheng Chongwei Relationship to Applicant: father Address: dongchaoyang road changchun jilin province china Contact Number: +86043188960375 (Home) +8613904319033 (Office) +8613904315060 (Handphone) 2nd EMERGENCY CONTACT Name: Zhou Jie Relationship to Applicant: mother Address: shenjiting yatai street panshi road changchun jilin province china Contact Number: +86043185265667 (Home) +86043185265027 (Office) +8613944862473 (Handphone)
(D) DECLARATION 1. I hereby declare that I have taken up this Overseas Programme of my own accord. 2. I agree to assume any and all risks which might be associated with this Overseas Programme and