Fields marked with "*" are compulsory

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/CDSCO” Licence

Source of information for Gamma Irradiation

Source of information for AV Processors

Any other Information you would like to mention

Contact Person Details

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Name

Designation

Telephone

Fax

Email

Mobile