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Bio-Medical Waste (Management and Handling) Rules, 1998

FORM I
(see rule 8)

APPLICATION FOR AUTHORISATION
(To be submitted in duplicate.)

To

The Prescribed Authority
(Name of the State Govt/UT Administration)
Address.

1. Particulars of Applicant

(i) Name of the Applicant
(In block letters & in full)
(ii) Name of the Institution:
Address:
Tele No., Fax No. Telex No.

2. Activity for which authorisation is sought:

(i) Generation
(ii) Collection
(iii) Reception
(iv) Storage
(v) Transportation
(vi) Treatment
(vii) Disposal
(viii) Any other form of handling

3. Please state whether applying for resh authorisation or for renewal:
(In case of renewal previous authorisation-number and date)

4. (i) Address of the institution handling bio-medical wastes:

(ii) Address of the place of the treatment facility:

(iii) Address of the place of disposal of the waste:

5. (i) Mode of transportation (in any) of bio-medical waste:

(ii) Mode(s) of treatment:

6. Brief description of method of treatment and disposal (attach details):

7. (i) Category (see Schedule 1) of waste to be handled

(ii) Quantity of waste (category-wise) to be handled per month

8. Declaration

I do hereby declare that the statements made and information given above are true to the best of my knowledge and belief and that I have not concealed any information.

I do also hereby undertake to provide any further information sought by the prescribed authority in relation to these rules and to fulfill any conditions stipulated by the prescribed authority.

Date : Signature of the Applicant
Place : Designation of the Applicant

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