Withdrawal of Consent Request

In order for NUS to verify the authenticity of the requester, NUS will contact you for verification in person and/or via other telecommunication channels such as telephone and email.

I consent to NUS using the following information to contact me for verification purposes and, in relation to my request.

* denotes mandatory fields.
* Full name
  Alias/Other name
* Contact number
* Email address
* NRIC/FIN number
* Passport number
* Date of birth
* What is your relationship with NUS? Current NUS student
Current NUS staff
NUS alumni
NUS donor
Former staff
Former NUS student (non-alumni)
Job applicant
Research subject
Student applicant
Student registered in programme not leading to a degree
For others, please specify :
Information for Verification Purpose

Please provide the relevant information about yourself.

  Name of school/faculty/institute
  Last programme name
  NUS student ID
  Year of registration
  Name of degree
 * Address
  Last job title
  NUS staff number
  Date of resignation/departure
  Type of degree
  Full-time/Part-time programme?
  Name of programme that you have applied
  Year of application
 * Date of job application
  Mode of application
  Job/Position that you have applied
 * Date of participation
  Research topic
 * Vendor name
  Incorporation ID
  Project name
  Any other information to identify you :
(E.g. any other programme(s)/degree(s), alternate email address, alternative contact number)

We want to make sure that a real person is submitting this request. Please key in the verification password.

We would like to find out your reason for wishing to withdraw your consent.

Terms & Conditions