DECLARATION FORM

I, (the registered owner’s name) (the registered owner’s identification number/passport) do and
hereby declare that :

1. I am the registered owner of a vehicle WMR 1094;

2. I would like to change the ownership of the vehicle at the Malaysian Road Transport
(RTD);
3. However, at this time I was unable to attend to the RTD office because I was located
(specify the country where the registered owner is located);
4. Accordingly, I appoint (specify the name of the representative) (identification number) to
represent me for the application to change the ownership of the vehicle at RTD;
5. I hereby fully assume and release the RTD from any liability in the event of any
unforeseen occurrance;

And I make this declaration in the belief that it is true, and in accordance with the provisions
of the Statutory Declaration Act 1960.

Created and in fact acknowledged by

called above
…………………………….…………………..
at ……………………………………………..
In the country ………………………………..
On …………………………………………...

In front of me,

……………………………………………….
Malaysian Embassy / Consulate in ……………..
(Embassy / Consulate name and official stamp)
 DECLARATION FORM

I, Rashed Yahya Awadh, Passport No. : the registered owner’s identification number/passport)
do and hereby declare that:

1. I am the registered owner of a vehicle WMR 1094;

2. I would like to change the ownership of the vehicle at the Malaysian Road Transport
(RTD);
3. However, at this time I was unable to attend to the RTD office because I was located
(specify the country where the registered owner is located);
4. Accordingly, I appoint Mohd Naim Bin Mahamed Hanifah, ID No. 900829025917 to
represent me for the application to change the ownership of the vehicle at RTD;
5. I hereby fully assume and release the RTD from any liability in the event of any
unforeseen occurrance;

and I make this declaration in the belief that it is true, and in accordance with the provisions
of the Statutory Declaration Act 1960.

Created and in fact acknowledged by

called above
…………………………….…………………..
at ……………………………………………..
In the country ………………………………..
On …………………………………………...

In front of me,

……………………………………………….….
Malaysian Embassy / Consulate in ……………..
(Embassy / Consulate name and official stamp)