Ref. N4A
Radiation Protection and Nuclear Science Department
National Environment Agency
Environmental Building, 3rd Storey, Annex Block
40 Scotts Road, Singapore 228231
Email: Contact_NEA@nea.gov.sg
Website: http://www.nea.gov.sg
This form will take approximately 15 minutes to be completed.
Every section of the application form MUST be duly completed. “N.A.” should be used when appropriate.
Application form without the details of the irradiating apparatus, incomplete application form, or incorrect payment will result in the rejection of this application.
For payment by cheques, the accompanying cheque must be submitted together with the completed application form, failing which the form will not be processed.
A copy of the invoice MUST accompany this application.
1. Particulars of the Organisation
Name:
Address:
Nature of Business:
Authorised Person:
2. Particulars of the company / person who will be in possession of the apparatus
Name:
Application:

Medical Diagnostic

Medical Therapeutic

Medical Surgery

Dental

Veterinary

Industrial

Entertainment

Education
Import Quantity:
@ Use separate sheet if more than one type of application.
Tel No.:
Licence N1 or N2 :
Fax No.:
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:



Domestic
Sun-tanning
Others (Please specify)
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4. Particulars of Transport (please circle where applicable)
Means of Transport:
Arrival Date (DD-MM-YYYY):
Country of shipment:
Ref. N4A
Sea / Land / Air
Name Supplier:
The items are under ATA Carnet Yes / No
Yes / No The items to be imported will be hand-carried by people through the checkpoint
My company has signed up a GIRO link with the National Environment Agency Yes / No / Information-unavailable
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
Notes:
1. The company named in section 1, which 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 import.
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, Radiation
Protection and Nuclear Science Department together with the name and address of the person to whom it was sold.
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
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8. Cheques should be made payable to “National Environment Agency”.
Ref. N4A
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