Download Application Form for Grant or Renewal of license for the operation of Blood Bank processing of whole human blood for components and/or manufacture of blood products

Application Form for Grant or Renewal of license for the operation of Blood Bank processing of whole human blood for components and/or manufacture of blood products. 1. I/We _____________________________________________ of _________________ ________________________________ hereby apply for the grant/renewal of license to operate blood bank , processing of whole human blood for components and/or manufacture of blood products. 2. The names of the Human Blood Components intended to be processed shall be specified ________________________________________________________________ 3. The name, qualification and experience of the support staff : (i) Name (s) Of Medical Officer _____________________________________________ (ii) Name (s) Of Nurse _____________________________________________________ (iii) Name (s) Of Blood Bank Technician ______________________________________ 4. The premises and plan are ready for inspection/will be ready for inspection on ______ 5. A fee of Rupees ___________________________________ and an inspection fee of Rupees ____________________________________ has been credited to the Government on account of _________________________ Date : Signature Designation