Form Request For Helmet/ Visor ICC Stickers

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.
Republic of the Philippines
Attachment 1
Provincial Office
Control #:
Name : Address: Contact No(s).:
Brand of Helmet:
Date Acquired: Source from/ Bought
from (Establishment/Location):
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.
– Others:
To Standards / Authorized Officers: Please encircle name of parts if available
– Helmet compliant with BPS MC 1-A:2012
– Helmet not compliant with BPS MC 1-A:2012
Action: Non-issuance
Issued ICC Sticker No.:
For issuance
Name & Signature of Standards Officer / Date

One thought on “Form Request For Helmet/ Visor ICC Stickers

  1. i have an old helmet the shell is still good but the paint and the brand name is tearing off i tear them out completely and repainted it so the brand name is it still valid to be registered?as of now i dont have money to buy anew one

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