Republic of Mauritius

RADIATION PROTECTION AUTHORITY (Services Unit)

37, Saint Georges Street, Port-Louis, Mauritius - Tel: (230) 2080307 - Fax: (230) 2080934 - Email: rpa@govmu.org

 

PERSONAL RADIATION MONITORING SERVICE (PRMS)

AMENDMENT FORM

Please fill in the form below and provide us with the necessary details

* are mandatory fields and need to be filled

1. Details of Subscriber

PRMS Subscriber Number* PRMS -
Name of Subscriber*
Type of Service*

2. Details of Amendment *

Number of Radiation Workers to be added
Number of Radiation Workers to be removed
Number of Control Dosimeters to be added
Number of Control Dosimeters to be removed
Effective Date
Date of Application

3. Details of Radiation Workers to be Added

1. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
2. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
3. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
4. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
5. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
6. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
7. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
8. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
9. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category
10. Surname
  Other Name(s)
  NIC Number Gender
  Radiation Worker Category

4. Details of Radiation Workers to be Removed

1. Surname
  Other Name(s)
  NIC Number
2. Surname
  Other Name(s)
  NIC Number
3. Surname
  Other Name(s)
  NIC Number
4. Surname
  Other Name(s)
  NIC Number
5. Surname
  Other Name(s)
  NIC Number
6. Surname
  Other Name(s)
  NIC Number
7. Surname
  Other Name(s)
  NIC Number
8. Surname
  Other Name(s)
  NIC Number
9. Surname
  Other Name(s)
  NIC Number
10. Surname
  Other Name(s)
  NIC Number