Form A. New Client Registration

User/Membership Registration

Step 1 of 5

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Account Expiry Date

CLIENT INFORMATION

Type of Client(Required)

Applicant (Representative) Name(Required)

First Name Last Name

Occupation/Position(Required)

Phone/Telephone Number(s)(Required)

Email(Required)

Password(Required)

Create and confirm password for your account here

Enter Password Confirm Password

Strength indicator

ENTITY INFORMATION

Business Location Category(Required)

Select the location category of your entity whether it is based locally (registered business, agents, clients and individuals in PNG) or overseas (entity based in other countries or has overseas address).

Purpose For Registration(Required)

For International Product Compliance and Certification (Homologation) purposes by Manufacturer Representatives and Homologation Agents.

For Commercial purposes (Papua New Guinea Licensed Dealers)

For Private and Non-commercial purposes by non-licensed dealers (local agent, business, agencies, individual, others)

Type of Entity(Required)

Entity Name(Required)

Registered Entity, Business or Organisation Name

Type of License(Required)

For NICTA existing Licensee, please select the type of your license from the drop down menu

License Number

Enter the license number

License Expiry Date

IPA Certificate Number

IPA Certificate Expiry Date

Expiry date for your IPA

IRC TIN

TIN Expiry Date

Expiry date for your IRC Tin

Website (optional)

Address

Address Line 1 Address Line 2 Town / City State / Province / Region ZIP / Postal Code Country