Sample Form Request For Helmet/ Visor ICC Stickers. Please note that this form is FREE. You could get a copy of this form at the designated DTI offices or download this here
. If somebody ask for money please report them to the Head of that department.
Name : Address: Contact No(s).:
Brand of Helmet:
Date Acquired: Source from/ Bought
I certify to the correctness of the above information and futher certify that the helmet has not been subjected to impact, dropped or used during a road accident.
Printed Name and Signature
Note: To be filled out by Standards Officer / Authorized Officer during evaluation:
Other description / identifying marks:
Condition of helmet:
a. Safety parts complete & not broken (Shell,
- retention system, protective & comfort paddings
b. No dents, deformation or breakage nor signs of
- cracking or appreciable distortion
- c. No traces of application of paint, stickers, petrol or other solvents
d. Brand name and size still evident on the face of
- the helmet. Brand has not been altered.