Part I - Particulars of Applicant:
Full Name: *
Name of Business : *
Address: *
(Location of your business)
Email Address: *
Phone Number: *
Part II - Brief Background:
Brief detail of business and staffing: *
Name of importing/exporting company: *
Name of importing/exporting country: *
Brief detail of the prescribed controlled substance involved: *
Brief detail of storage capacity: *
Purpose of application: *
Part III - Application Declaration
I declare that the information I have provided is true and correct. I understand that it is an offence to give information false and misleading information. *
Date: *
MM
/
DD
/
YYYY
Submission Requirement
Business Registration Certificate: *
(from Commerce Office)
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Required
Valid Operational License: *
(from Council)
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Required
Payment Receipt of the General License Fee: *
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Required
Supplier Exporting License of Controlled Substances: *
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Required
Qualification of all technicians from recognized Institutions: *
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Required
References from Customers (at least 3): *
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Required
Applicant e-signature
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