Format of undertaking by the supplier/service agency to be provided to the pre-owned users

To,
<< Hospital name and Address>>

Details of the equipment

Type of Equipment:
Model Name: Serial Number:
Year of manufacture:
Expected residual useful life of x-ray equipment:

I/We hereby undertake

1. to install, commission, carry out acceptance testing,servicing and maintenance of the pre-
owned x-ray equipment till its useful life,
2. to provide the technical catalogue, service, QA & design manual, exposure protocols,
3. to ensure availability of required protective accessories for the supplied equipment
4. to provide education and training for use of the x-ray equipment to the user;
5. to provide installation report, acceptance test report and radiation survey report of x-ray
equipment/installation to facilitate for obtaining licence for operation from AERB,
6. to provide copy of latest QA report (not more than six months old) authenticated by previous
end-user of pre-owned diagnostic x-ray equipment,
7. to provide copy of operating licence of previous user,
8. to verify the room layout plan as per the AERB guideline before installing the equipment,
9. to decommission the x-ray unit after its useful life.

This undertaking is provided to the ser institution to fulfill the regulatory requirements for import and
supply of pre-owned x-ray equipment.

(Signature) Name of the supplier/service agency Signature of Institution’s Representative:

Address of supplier/service agency Name of Institution:
Seal of supplier/service agency Seal of the Institution:
Date Date