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Name of the Organization: *
Whether You are Manufacturer   Dealer
Address:(Manufacturing unit):
Address:(Administrative office): *
Product Requiring Irradiation: *
Nature of Product: *
Whether it is for * R&D   Commercial
Whether the product was * Irradiated Earlier   It Is 1st Time
Whether the product is * Packing Material   Finished Product
If Packing Material, whether made of * Plastic   Metal   Glass
Purpose of Irradiation:
Dose Requirement:
Usage of Product:
Method of Primary Packaging of Product: *
Whether Product requires FDA Loan Licence: *
Source of information for Gamma Irradiation:
Source of information for AV Processors:
Any other Information you would like to mention: *
Contact Person Details: *  
Name: *
Telephone: *
Email: *

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