QUALITY COUNCIL OF INDIA (QCI)

2nd Floor, Institution of Engineers Building, Bahadur Shah Zafar Marg, New Delhi – 110002

WORKPLACE ASSESSMENT for SAFETY & HYGIENE (WASH)

A Scheme by Quality Council of India

APPLICATION FORM FOR REGISTRATION AS ASSESSMENT AGENCY

(Only NABCB accredited agencies/bodies are eligible to register)

Please complete this application form and send it to QCI at wash@qcin.org

PART I: GENERAL INFORMATION

1. Name of the Agency

2. Address of Main Office

City
State PIN

Name
Designation
Single Point of Contact Phone
3.
(SPOC)
Mobile
E-mail

Details of NABCB
4. Accreditation
Please specify Accreditation
Cert. No. and Validity Period

Sector Scope(s) of
5.
Accreditation

Preferred States where

6. the Agency/Body would
undertake assessments

7. PAN Number

8. GSTIN Number

WASH/QCI/2020/APPLICATION FORM FOR REGISTRATION OF ASSESSMENT AGENCY Page 1 of 2

 QUALITY COUNCIL OF INDIA (QCI)
2nd Floor, Institution of Engineers Building, Bahadur Shah Zafar Marg, New Delhi – 110002

PART II: UNDERTAKING

I/We, on behalf of _______________________________________________________________ which has

applied for registration as an assessment agency under WORKPLACE ASSESSMENT for SAFETY &
HYGIENE (WASH) Scheme of QCI, hereby undertake/declare that
i. The information given in this application form is true.
ii. Validity of this registration as an assessment agency will run concurrent with the validity of NABCB
accreditation.
iii. The Scheme document, Standard, assessment procedures and other documents have been read,
understood and agreed to as applicable.
iv. I/We shall comply with all the guidelines under WASH standard and shall conduct all assessments in
an impartial manner and shall not indulge in any unfair practices.
v. I/We agree to the financial terms and conditions of QCI under the WASH Scheme.
vi. I/We have adequate resources to conduct assessment under the WASH Scheme.
vii. I/We will inform QCI, about any changes in information submitted in this form and any other
document, including change in addresses and phone nos., from time to time.
viii. I/We understand that our performance will be reviewed by ZED-QCI frequently and if found
unsatisfactory, we may be removed from the list of registered agencies/bodies under WASH Scheme.
ix. QCI is not bound to accept this application and may reject all or any applications for registration under
the WASH Scheme without assigning any reason or giving any explanation whatsoever.
x. It is understood that this is merely an application and does not entitle us to be necessarily qualified by
the QCI.

Signatures of Authorized Signatory 1. 2.

Name
Designation
Date
Place

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