Professional Documents
Culture Documents
Complete this application form and the supplementary form, and return both duly signed to the Regulatory Body with the fee, if
required. Where space is insufficient for any item, attach additional signed sheets.
1. Name and address of the applicant (i.e. the operator / legal person):
Tel:
Fax:
E-mail:
2. Location of the premises where the radiation practices and sources are to be used:
3. Field of application and purpose(s) for which the radiation practices and sources are to be used:
4. Name, qualifications, experience and contact details of the person nominated to be the Radiation
Protection Officer:
5. Names, qualifications, experience and contact details of the Qualified Expert(s) retained to advise the
applicant:
6. For sources used for medical exposure, the names, qualifications, experience and contact details of the
medical practitioners who are to be designated by name in the registration or license:
a) “Use” means to possess, store, manufacture, sell, operate, import, export or any other meaning given in
the legislation.
b) “Radiation Source” means any radioactive substance and any electrical device that produces ionizing
radiation when energized. It includes sources that the owner or the person in possession has reason to
believe are, or should be, exempt from regulatory control. The Regulatory Body will rule on the exemption
status of any particular source and inform the holder accordingly.
c)
INSTRUCTIONS:
Date: _______________________________________
RADIATION CONTROL LEGISLATION
1
For sealed sources include the date at which the activity applies.
2
Solid, liquid, gas, sealed, unsealed.
Date: _______________
Fee Schedule for Authorization/Licensing/Renewal
Schedule-I: License/Authorization and Renewal Fee
B) Dosimetry Services