SECOND SCHEDULE
Rule 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 issued
Approximate 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 …………………..…….