Singapore Customs
Tariffs & Trade Services Branch
55 Newton Road #07-01
Revenue House
Singapore 307987
Tel No. : 6256 1281
Fax No. : 6337 6361
Email: [email protected]
APPLICATION FOR DETERMINATION OF STRATEGIC GOODS
This form may take you 20 minutes to fill in.
You will need the following information to fill in the form:
(a) Particulars of applicant;
(b) Particulars of product manufacturer;
(c) Technical specification(s)/ datasheet(s)/ brochure(s) of product;
(d) Safety Data Sheet (SDS) or Certificate of Analysis (COA);
(e) Export licence(s) or Authorisation(s); and
(f) Intended end-use of the product.
Please fill in all fields. Indicate “NA” if the field is not applicable. Each application is for the determination of ONE
product. Please complete the form and return it, together with the relevant supporting documents, via email, fax or
post.
FOR OFFICIAL USE
Application No.:
SECTION A
Date Received:
APPLICANT’S INFORMATION
(1) Application Type:
Organisation
Individual
(2) Name:
(3) Unique Entity Number (UEN):
(4) Address:
(5) Contact Person’s Name and Designation
(6) Contact No.:
(7) Fax No.:
(8) Email:
SECTION B
PRODUCT INFORMATION
Please attach the relevant product questionnaire downloadable from the Strategic Goods Control website
(http://www.customs.gov.sg/stgc/topNav/ese/Forms.htm) as ANNEX A, the operating and technical
instructions/brochures/pictures/diagrams and any other helpful information on the item as ANNEX B and the Safety
Data sheet (SDS) or Certificate of Analysis (COA), if the product involves chemical items, as ANNEX C.
(9) Product Name:
(10) Describe in detail the functions and applications of product:
SC-A-064 (Ver 10 – 11/15)
Page 1 of 4
(11)Part No.:
SECTION C
(12)Model No.:
(13)Brand:
MANUFACTURER’S INFORMATION
(14) Manufacturer’s Name:
(15) Manufacturer’s Address:
(16) Country of Manufacturer:
(17) Website Address:
(18) Is the product already imported or intended for import into Singapore?
Yes
No
If ‘Yes’, please state the following:
(a) Where was the product (will the product be) imported from? (Name the country.)
(b) Is an export licence required to export the product from the country stated in (18)(a)?
No export licence required
Export licence no.:
(Please attach a copy of the export licence as ANNEX D.)
Export licence exemption
(Please attach proof as ANNEX D.)
If unable to attach copy of the export licence or proof of export licence exemption, please explain why:
(19) Is the product or any of its components specially designed for military use?
Yes
SECTION D
No
END-USE INFORMATION
(20) What is the intended end-use of the product? (Tick the appropriate end-use for all (a), (b) and (c).)
(a)
Weapons of Mass Destruction (WMD)
(b)
Military
(c)
Government
Non-WMD
Non-military
Non-government
(d) Describe in detail the intended end-use.
SC-A-064 (Ver 10 – 11/15)
Page 2 of 4
(21)Is the product intended for a higher assembly?
Yes
No
If ‘Yes’, please state the following:
(a) What is the next higher assembly?
(b) Is the product specially designed for the next higher assembly?
Yes
No
If ‘Yes’, please state the following:
(i) Describe in detail the higher assembly, and submit the relevant product information (product
brochure/technical specifications):
(c) What is the intended end-use of the next higher assembly? (Tick the appropriate end-use for all (a), (b) and (c).)
(i)
Weapons of Mass Destruction (WMD)
(ii)
Military
(iii)
Government
Non-WMD
Non-military
Non-government
(iv) Describe in detail the intended end-use of the next higher assembly.
SECTION E
ADDITIONAL INFORMATION
(22) Does the product contain any parts which are controlled under the Strategic Goods (Control) Act?
Yes
No
If ‘Yes’, please list them here.
(Please attach additional sheet(s) if necessary.)
S/N
Part Description
Part No.
Strategic Goods Product
Code
i.
ii.
iii.
iv.
v.
(23) Remarks (if any):
SC-A-064 (Ver 10 – 11/15)
Page 3 of 4
SECTION F
SUPPORTING DOCUMENTS
(24) Please submit the following relevant supporting documents (via email, fax or post) to Singapore Customs,
together with this application form. All supporting documents are to be numbered and the total number of pages
indicated at the top right-hand corner of every page. Please tick below for the supporting documents submitted.
Annex A – Product Questionnaire, as applicable (This can be downloaded from the Strategic Goods Control
website.)
Annex B – Technical Specification(s)/Datasheet(s)/Brochure(s) of the product stated in Section B
Annex C – Safety Data sheet (SDS) or Certificate of Analysis (COA) if the product in Section B involves
chemical items
Annex D – Export Licences or licence exemptions, and their corresponding translation in English, if any
Annex E – Other relevant supporting documents, if any. Please state:
SECTION G
DECLARATION AND UNDERTAKING
(25)Do you allow Singapore Customs to make available the product information (e.g. product name, brand, model
number, etc.) and its determination outcome in public domain?
Yes
No
(26)I/We declare that all the information provided above is true and correct, to the best of my/our knowledge.
(27) Name:
(28) NRIC/Passport No.:
(29) Designation (For organisation only):
(30) Contact No.:
(31) Fax No.:
(32) Email:
(33) Signature:
(34) Date (dd/mm/yyyy):
SC-A-064 (Ver 10 – 11/15)
Page 4 of 4