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REQUEST TO INCLUDE AUTHORISED PERSON TO ACCESS TLS (EQUIPMENT REGISTRATION)
Name of Licensee (Company Name) *
UEN *
Dealer Licence Number *
DETAILS OF AUTHORISED PERSON TO ACCESS TLS FOR THE ABOVE LICENCE
1) Name : *
2) NRIC No/Passport No : *
3) Nationality : *
4) Gender : *
5) Email : *
6) Contact Number : *
PUBLIC CONTACT NUMBER OF LICENSEE TO BE PUBLISHED ON IMDA'S WEBSITE
Public Contact Number : *
DETAILS OF AUTHORISING IMDA’S LICENSEE (to be completed only if the above additional user is an Agent)
Authorising Organisation Name
Authorising Officer’s Name
Contact Number
Email
 

I declare that I am authorised to make the above request on behalf of the above-mentioned licensee and the information provided herein is not false or misleading. I understand that the above request will be rejected by IMDA if the information provided is found to be untrue, incorrect or inaccurate.