Form Pab01 - Application For Approval Of Power-Assisted Bicycles printable pdf download

10 Sin Ming Drive Singapore 575701

PAB01

Tel: 1800-CALL LTA (1800-2255 582) Fax: (65) 65535329

APPLICATION FOR APPROVAL OF POWER-ASSISTED BICYCLES (PAB)

You may take about 10 minutes to complete this form. You will need the following information to fill in the form:

• • • • Detailed technical specifications and particulars of PAB model

• • • • Applicant’s name and NRIC number (Singaporeans, Singapore PRs and Malaysians) or Passport number (Foreigners other than Malaysians) and/or

particulars of Company/Business such as Name of Company, ACRA certificate number, and contact numbers

• Company Stamp (if applicable)

IMPORTANT: Please read the INSTRUCTIONS & NOTES overleaf before completing the form. Applications with incorrect or incomplete

information will not be accepted.

Type of Application:

Type Approval

Sealing of PAB(s) (Please state quantity:_____)

(Please tick

“√”

ONE only)

SECTION A – DETAILS OF PAB

Make: ________________________________________

Model: ___________________________________________

Manufacturer: __________________________________

Country of Manufacture:______________________________

Technical Requirements (tick “√” box if it applies to your PAB)

FOR OFFICIAL USE ONLY

Similar to a conventional bicycle (i.e. no horizontal platform

between the 2 wheels; no excessive body panels and etc)

Maximum continuous rated power of motor of up to 250 watts

Safety features

a. Motor does not operate when rider pedals backwards

b. Motor power cuts in only when rider starts to pedal forward

and motor must stop when the rider stops pedalling

c. Motor power progressively reduces and finally cuts off when

the bicycle reaches a speed of 25 km/h

d. Unladen weight of the PAB is less than or equal to 20 kg

e. No throttle or buttons or start up assist etc to bypass the

safety/pedal assist features

Additional features (e.g. pillion seat, carrier) _______________________________________________________________________________

__________________________________________________________________________________________________________________

SECTION B – APPLICANT’S PARTICULARS AND DECLARATION

I/We

declare that I/we*:

have ensured that the particulars furnished in this application and its other supporting documents are true and correct to the best of my/our*

knowledge.

have been briefed on the legal consequences

should I/we* alter, sell or supply or cause or permit to sell, supply, offer or alter the PAB(s) in

such condition that the use in that condition would be unlawful under the Road Traffic Act.

undertake not to supply or sell any PAB(s) for use on public roads unless the PAB(s) has been approved and affixed with the LTA seal.

undertake not to use or allow the use of any PAB(s) on public roads unless the PAB(s) has been approved and affixed with the LTA seal.

Applicant’s Name: _________________________________________

Company’s Name: ____________________________________________

Applicant’s NRIC / Passport no: _____________________________

ACRA Certificate No: __________________________________________

Applicant’s Contact No: ______________________________________

Company Address: ____________________________________________

Company Contact No: _____________________________________

Signature of Applicant & Company Stamp (if applicable) ___________________________________________

Date: ____________

Delete where inapplicable

Under the Road Traffic Act, any person who alters or causes or permits the vehicle to be altered in such condition that the use thereof in that condition would be

unlawful is liable to an offence. First-time offenders shall be liable on conviction to a fine not exceeding $2,000 or a jail term not exceeding 3 months. Repeat

offenders shall be liable on conviction to a fine not exceeding $5,000 or a jail term not exceeding 6 months

The information is current at time of printing (Mar 2016)

VE-F-PAB01-V02 (03/2016)