FORM H - PERMANENT RECORD OF APPLICATION FOR REGISTRATION, GRANT OF REGISTRATION REJECTION OF APPLICATION FOR REGISTRATION AND RENEWALS OF REGISTRATION

[See Rule 9(5)]

 1.Sl. No.

2.File number of Appropriate Authority.

3.Date of receipt of application for grant of registration.

4.Name, Address, Phone/Fax etc. of Applicant:

5.Name and address(es) of Genetic Counselling Centre*/Genetic Laboratory*/Genetic Clinic*.

6.Date on which case considered by Advisory Committee and recommendation of Advisory Committee, in summary.

7.Outcome of application (state granted/rejected and date of issue of orders).

8.Registration number allotted and date of expiry of registration.

9.Renewals (date of renewal and renewed upto).

10. File number in which renewals dealt.

11. Additional information, if any.

                                Name, Designation and Signature of  Appropriate Authority

Guidance for Appropriate Authority

(a) Form H is a permanent record to be maintained as a register, in the custody of the Appropriate Authority.

(b)* Means strike out whichever is not applicable.

(c) Against item 7, record date of issue of order in Form B or Form C.

 (d) On renewal, the Registration Number of the Genetic Counselling Centre/Genetic Laboratory/Genetic Clinic will not change. A fresh registration Number will be allotted in the event of change of ownership or management.

 (e) No registration number shall be allotted twice.

 (f) Each Genetic Counselling Centre/Genetic Laboratory/Genetic Clinic may be allotted a folio consisting of two facing pages of the Register for recording Form H.

 (g) The space provided for ‘additional information’ may be used for recording suspension, cancellations, rejection of application for renewal, change of ownership/management, outcome of any legal proceedings, etc.

 (h) Every folio (i.e. 2 pages) of the Register shall be authenticated by signature of the Appropriate Authority with date, and every subsequent entry shall also be similarly authenticated.