Ref by xiuliliaofz


									                                                                                                         Ref. N4A

Centre for Radiation Protection and Nuclear Science
National Environment Agency
Environmental Building, 3rd Storey, Annex Block
40 Scotts Road, Singapore 228231

                                       RADIATION PROTECTION ACT 2007

                              APPLICATION FOR LICENCE TO IMPORT

             Every section of the application form MUST be duly completed. Incomplete forms will not be processed.
             “N.A.” should be used when appropriate.
             A copy of the invoice MUST accompany this application.

1.       Particulars of the Organisation


Address:                                                                                  Tel No.:

Nature of Business:                                                                       Licence N1 or N2 :

Authorised Person:                                                                        Fax No.:

2.       Particulars of the company / person who will be in possession of the apparatus


Address:                                                                                   Tel No.:

Nature of Business:                                                                        Licence N2:

Contact Person:                                                                            Fax No.:

3.    Particulars of the apparatus for which licence is sought (Brochures/Technical Data/Test Reports, etc.) should be attached

Type:                                           Maker/Manufacturer:                        Model Number:


     Medical Diagnostic                            Veterinary                                Domestic

     Medical Therapeutic                           Industrial                                Sun-tanning

     Medical Surgery                               Entertainment                             Others (Please specify)

     Dental                                        Education

         Use separate sheet if more than one type of application.

4.       Particulars of Transport

Means of Transport:             Sea / Land / Air
Country of shipment:                                                  Supplier:

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                                                                                                          Ref. N4A

5.       (Note: The applicant must be a person who is authorized to represent the company.)

I hereby apply for a licence to import the irradiating apparatus specified above and declare that all the particulars contained in
this application are correct and true.

The National Environment Agency (NEA) collects personal information to carry out its various functions and duties under
the National Environment Agency Act (Cap 195) including the implementation of environmental and public health policies in
Singapore and any other related purposes. I hereby consent to NEA’s use of the information provided by me in the course of
any application I have made to the NEA, to facilitate the processing of such application for such purposes. I hereby further
consent to NEA sharing the information in such application with other Government agencies, or non-government entities
authorised to carry out specific government services, unless prohibited by legislation.

                    Signature of Applicant                                                       Date


1.    The company named in section 1, who is applying for IMPORT licence MUST be the holder of a licence authorising
      possession of the irradiating apparatus under application reference N1 or N2. This application must be completed and
      signed by the duly authorised officer of the company named in section 1. It cannot be signed by a forwarder on behalf
      of the company.

2.    Whenever possible, applicants are encouraged to use the online TradeNet system to apply for the N4A licence instead
      of doing a physical hardcopy submission.

3.    The company named in section 2 is the company to whom the irradiating apparatus is to be sold or delivered after

4.    A separate application is required for each consignment.

5.    The attention of an agent importing irradiating apparatus for sale, is drawn to Section 6(2) of the Radiation Protection
      Act 2007, which requires that notice of every sale of irradiating apparatus shall be given to the Director-General of
      Environmental Protection, National Environment Agency. This application form is to be submitted to the Director,
      Centre for Radiation Protection and Nuclear Science together with the name and address of the person to whom it was

6.    It is the responsibility of the applicant, and the licensee, to ensure that medical irradiating apparatus comply with any
      other applicable regulatory requirements of other regulatory bodies in Singapore (e.g., the Health Sciences Authority.)

7.    The completed application form should be submitted together with the prescribed fee of $40/- to

                              Centre for Radiation Protection and Nuclear Science
                              National Environment Agency
                              Environment Building
                              3rd Storey, Annex Block
                              40 Scotts Road, Singapore 228231

8.    Cheques should be made payable to “National Environment Agency”.

Version 1.2 / Aug 2011                                                                                                          2

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