(see rule 8)
APPLICATION FOR AUTHORISATION
(To be submitted in duplicate.)
The Prescribed Authority
(Name of the State Govt/UT Administration)
1. Particulars of Applicant
(i) Name of the Applicant
(In block letters & in full)
(ii) Name of the Institution:
Tele No., Fax No. Telex No.
2. Activity for which authorisation is sought:
(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
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.