Download Word Doc - Singapore Customs

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]
ANNEX A - PRODUCT QUESTIONNAIRE
A-3 BIOLOGICAL PRODUCT
SECTION A
BASIC PRODUCT INFORMATION
(1) Name of the Manufacturer:
(2) Brand:
(3) Model No./Part No.:
SECTION B
DETAILS OF THE BIOLOGICAL PRODUCT
(4) Please provide details (Binomial nomenclature / Scientific name) of the Biological Product.
(5) What is the classification of the Biological Product?
(a) Human Pathogen
Virus
Bacteria
Toxin
(b) Animal Pathogen
Virus
Bacteria
Toxin
(c) Plant Pathogen
Virus
Bacteria
Toxin
(d) Others
Mycoplasma mycoides
Infectious / Pathogenic organism
Genetic elements and genetically modified organisms belonging (a), (b) or (c)
Others (please specify):
SC-A-064C (Ver 1 – 04/13)
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(6) If the Biological Product is infectious/pathogenic, please provide the list of procedures taken:
(7) Is the primary use of the Biological Product any of the following?
(a) For Biological Weapon Production
Yes
No
(b) For Research purposes
Yes
No
(c) For Analytical purposes
Yes
No
(d) For Academic purposes
Yes
No
(e) For Vector control purposes
Yes
No
(f) Others:
(8) Please state if there is any other application(s):
SECTION C
DECLARATION
I/We declare that all the information provided is true and correct, to the best of my/our knowledge.
(9) Name:
(10) NRIC/Passport No.:
(11) Designation:
(12) Contact No.:
(13) Email:
(14) Fax No.:
(15) Signature:
(16) Date(dd/mm/yyyy):
SC-A-064C (Ver 1 – 04/13)
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