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)

APPLICATION 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 Applicant

Name of Applicant*

2. Details of Contact Person
Name*
Designation
Address*
Email*
Tel* Fax
Date of Application

3. Type of Service Required *
Please select one type of service. Use separate Application Form if more than one service is required.
 
A
 Whole Body Dosimeters (Monitoring Period 3 Months)
B
 Whole Body Dosimeters (Monitoring Period 1 Month)
C
 Wrist Dosimeters (Monitoring Period 3 Months)
D
 Wrist Dosimeters (Monitoring Period 1 Month)

4. Details of Service Required *
Number of Radiation Workers to be monitored
Number of Control Dosimeters required
Total Number of Dosimeters required

5. Details of Radiation Workers to be monitored

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

6. Attachment
Please attach a copy of
(i) the Business Registration Card
(ii) the National ID (for Individual Applicants), or (Max file size 5Mb)
(iii) Passport (for foreigners)