Republic of Mauritius

RADIATION PROTECTION AUTHORITY

APPLICATION FOR REGISTRATION OF A RADIATION SOURCE

 

Note: Please read the associated Guide for Applicant for instructions to complete this application form.

 * are mandatory fields and need to be filled

1. Type of Application

Please select one option *
Application for the registration of a radiation generator
Application for the registration of a sealed source

2. Applicant

Name *
Licence Certificate Number * LIC - -

3. Contact Person

Name *
Designation
Address *
Telephone Number *
Fax.
Email address *

4. Declaration

I declare that, to the best of my knowledge and belief, all information contained herein, including any supplements attached hereto, are true, accurate and complete.

 

Date :

Note: Separate application form should be submitted for the registration of more than one radiation source

5. Details of Radiation Generator

A Details of Radiation Generator
A.1 Type *
A.2 Max. kV *
A.3 Max.mA *
A.4 Make *
A.5 Model *
A.6 Serial Number *

A.7 Utilisation Mode *

Fixed Mobile Portable

B B.1 Acquisition of Radiation Generator *
Note:(Please provide brief details on the acquisition of the radiation generator)

6. Details of Sealed Source

A

 Details of Sealed Source
A.1 Radionuclide *
A.2 Serial Number
A.3 Maximum Activity *       Unit *  
A.4 Activity Date *
Details of Associated Equipment
A.5 Type
A.6 Make
A.7 Model
A.8 Serial Number

A.9 Utilisation Mode *

Fixed Mobile Portable
B B.1 Acquisition of Sealed Source and/or Associated Equipment *
Note:(Please provide brief details on the acquisition of the Sealed Source and/or Associated Equipment)

7. Additional Information

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)