Radiation Protection and Nuclear Science Department
National Environment Agency
Environmental Building, 3rd Storey, Annex Block
40 Scotts Road, Singapore 228231
Email:
Website: http://www.nea.gov.sg
RADIATION PROTECTION ACT 2007
APPLICATION FOR A LICENCE TO EXPORT
IONISING RADIATION IRRADIATING APPARATUS
This form will take approximately 15 minutes to be completed. Please ensure that you are using the latest version.
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.
1. Name of firm / organisation:(See Note 1) / 2. Company Stamp:
3. Address:
4a. Contact Person: / 4b. Designation:
4c. NRIC / FIN No.: / 5. Email address:
6. Tel. No.: / 7. Fax. No.:
H.P. No.:
8. Licence No. covering possession: / L1 / / /
or
L3 / / /
9. Name and address of company who has been in possession of the irradiating apparatus:
Company Unique Entity Number (UEN):
10. Particulars of the irradiating apparatus for which licence is sought:Qty
/Type / Purpose
(medical, dental industrial)
/ Maker / Manufacturer / Model /Specifications
(kV, mA, s/n)11. Recipient: / 12. Means of Transport:
@Air / Sea / Land
13. Country of Destination: / 14. Departure Date:
@ Delete as appropriate
15. Mode of payment* (Check with your Finance Department before completing this section – Please Tick One Only):
Payment by GIRO (Your company must have a RPNSD Giro Account)Payment by cheque – Bank/cheque No: ______(Please refer to Notes below.)
Payment by NETS or Credit Cards at NEA Customer Service Counter
*Note: Unless specially requested, the invoice and the receipt will be sent to the company address provided at Sections 1 & 3 above. Cheques should be made payable to “National Environment Agency”. Payment by methods not specified above is liable to be rejected and will cause processing delay to your application.
Export Licence / Fees / Please Tick OneL7B / $ 40/- / ( )
16. I hereby apply for a licence to export the above consignment of irradiating apparatus and declare that all the particulars contained in this application are correct and true.
I acknowledge that any fee paid for this application is not refundable, including in the event where the application is rejected or cancelled.
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 consentto 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.
Name of Applicant /
Designation of Applicant
Signature of Applicant /
Date
Notes:
1. The company named in section 1, which is applying for an EXPORT licence MUST be registered with an L1 or L3 licence. The L1 or L3 licences should be stated in section 8. This application must be completed and signed by the authorised officer of the company in section 1. The form cannot be signed by a forwarder on behalf of the company.
2. The company named in section 9 should be the company to whom the irradiating apparatus is to be sold or delivered after import.
3. This application should be used for consignments of ionising radiation irradiating apparatus, such as X-ray machines. For the export of radioactive materials, the L8B licence should be applied for instead. The L8B licence is also applicable for equipment containing a radioactive source, such as radiography projectors, nuclear gauges and electron mobility spectrometers.
4. A separate application is required for each consignment. A consignment which contains both irradiating apparatus and radioactive material as separate items will require both the L7B and L8B licences.
5. The completed application form should be submitted together with prescribed fee of $40/- to:
Head, Ionising Radiation Control Section
Radiation Protection and Nuclear Science Department
National Environment Agency
Environment Building
3rd Storey, Annex Block
40 Scotts Road, Singapore 228231
Version 1.7 / Dec 2017 3