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Declaration and Application for Issue of An International Circulation Permit

Road Traffic (International Circulation) Rules

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SECOND SCHEDULERule 5(1)Declaration and Application for Issue of An International Circulation Permit I request that you will issue to me a permit for the motor vehicle described below: 1.Description of motor vehicle (e.g. motor car, motor cycle, etc.) ……………………………………………………………………..……….2.Make of motor vehicle ……………………………………………………..3.Chassis No. ……………………………………………………...…………4.Engine No. ……………………………………………..………………….5.Shape ...........................................................................................................6.Colour .........................................................................................................7.Letters and numbers on the identification plates (if any) …....................... .....................................................................................................................8.Number of seats .......................................................................................... I undertake to surrender the permit on or before its expiry to the Authority by whom it was issued. I declare that I intend to make only a temporary stay in Singapore. I understand that if I use the motor vehicle on public roads in Singapore at any time when I hold no valid international circulation permit, I shall become liable to the ordinary licence fee; and I declare that I have held no international circulation permit during the last 12 months except as follows: Where issuedApproximate period for which used..............................................................................................................................................................................................................................................Signature of owner ................................................................................................Name in full (Mr./Mrs./Miss) ......................................................................... (in BLOCK CAPITALS)Passport No. ........................................................................................................Date and place of issue .........................................................................................Address in Singapore ............................................................................................Permanent place of residence (Home address) …………………………………..............................................................................................................................Port of landing ………………..............Date of landing ………………….Permit No. …………….Date of issue ………….Date of expiry ..............Country where the motor vehicle is registered ………………………………….I.C.M.V. No. ………….Issued by ……………...Expiry date ………..….Certificate of Insurance/Cover Note No. ……………Issued by ……………………………...…… on ………………... expiring on …………………..…….

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