Raffles Shield Application
Fill up the form below to register your interest. This should take less than 2 minutes.
Medical Conditions:
- Cardiovascular
- Heart disorder
- Respiratory
- Lung disorder
- Endocrine
- Metabolic disorder
- Neurological
- Brain
- Spine
- Nerve disorder
- Psychological
- Mental disorder
- Gastroenterological
- Digestive disorder
- Cancer
- Liver disorder
- Kidney or bladder disorder
- Bones, joints or skin disorder
- Blood disorder
- Eye, ear
- Nose or throat disorder (excluding long and short sightedness)
- Bleeding disorder from anus or rectum
Please note that this list is not exhaustive.
Relationship To Applicant
- Husband
- Wife
- Father
- Mother
- Step-father
- Step-mother
- Legal guardian
- Son
- Daughter
- Step-son
- Step-daughter
- Brother
- Sister
Please note that this list is not exhaustive.