FORM NO. 9-A

Pakistan Nuclear Regulatory Authority

P. O. Box No. 1912, Islamabad.

APPLICATION FORM FOR REGISTRATION OF THE PREMISES AND LICENSING OF RADIOACTIVE MATERIAL/RADIATION APPARATUS USED FOR EDUCATION & RESEARCH

1.  Particulars of the applicant (attach copy of the C.N.I.C)

Name: / CNIC No. / - / -
Title(Owner, Director, etc):
Address: / Tele. No.:
Fax No.
e-mail:

2.  If applicant is not the owner, particulars of the owner.

Name: / CNIC No. / - / -
Address: / Tele. No.:
Fax No.
e-mail:

3.  Purpose for which licence is required

4.  Location of Research/Education Centre

Name of Research/Education Centre:
Address (including Tehsil, District):

5.  Particulars of Radioactive Material (s):

Manufacturer / Model
Number / Identification
Number / Radionuclide / Manufacturing date and Initial
Activity / Number of Sources / Date of acquisition / Supplier

6.  Specification of Radiation Apparatus (Please attach operation manual of apparatus)

Sr.
No. / Model/Make / ID. No. / Serial No. / Maximum Voltage (kV) / Maximum Current (mA) / Date of acquisition / Supplier
1. 
2. 
3. 

7.  Specifications of Accelerator(s) (Please attach operational manual/SAR of accelerator)

Sr.
No. / Model/Make / ID. No. / Serial No. / Type / Maximum Energy
(MeV) / Date of
acquisition / Supplier
1. 
2. 

8.  Particulars of radiation workers.

Sr.
No. / Name / Age / Qualification / Experience/Training
1. 
2. 

9.  Arrangements for personal dose monitoring from dosimetery services from

Ø  PINSTECH, P. O. Nilore, Islamabad OR

Ø  KIRAN Hospital, Near Safoora Goth, KDA Scheme-33 Gulzar-e-Hijri, Karachi

Yes No

10.  Detail of available Personal Protective Equipments (PPE).

11.  Radiation monitoring instrument (s) (if any)

Type of
Instrument / Number of
Instrument(s) / Radiation
Detected / Sensitivity Range
(R/hr)/ (Sv/hr) / Calibration
Expiry Date

12.  Arrangements for Security of Radioactive Material (s).

13.  Detail of radiation protection program as appropriate for the material to be used, including general radiation safety procedures, emergency procedures etc.

14.  Arrangements for the radioactive waste management.

15.  Particulars of Pay Order/Bank Draft as licence fee in favour of “Director Finance PNRA, Islamabad” :-

Pay Order/Bank Draft Number

Amount

Date

Name of the Bank

10.  Please check the following:-

i. Copy of C.N.I. Card Yes No

ii. Pay order/bank draft attached. Yes No

I, hereby, affirm that all the particulars given above are correct to the best of my knowledge and belief and I undertake to abide by the provisions of PNRA Ordinance- 2001, Regulations for the Licensing of Radiation Facility (ies) other than Nuclear Installation(s) - PAK/908, Regulations on Radiation Protection - PAK/904 and any other conditions imposed by the Authority from time to time including any guidelines or amendments/revisions issued thereto.

Signature of the owner ______Signature of the applicant ______

Dated: ______Dated: ______

Seal of Office ______

______

Note:

Ø  Use supplemental sheets where necessary.

Ø  Mail the completely filled application form along with all relevant documents to the concerned “Regional Nuclear Safety Directorate”.

(For details please contact your respective RNSD).

RNSD-I, Islamabad 051-9263019, RNSD-II, Kundian 0459-924294, RNSD-III, Karachi 021-9266282

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