Health Department 9b[FORM 27-C (See Rule 122-F) Application for grant or renewal of licence for the operation of Blood Bank, processing of whole human blood for components and/or manufacture of blood products 1. I/We ..............[of]9ba ......hereby apply for the grant/ renewal of licence to operate a Blood Bank, processing of whole human blood for components and/or manufacture of blood products. Names of the Human Blood Components intended to be processed shall be specified. 2. The names, qualifications and experience of expert staff. (a) Name(s) of Medical Officer. (b) Name(s) of Registered Nurse. (c) Name(s) of Blood Bank Technician. 3. The premises and plan are ready for inspection/will be ready for inspection on .......... 4. A fee of rupees .......... and an inspection fee of rupees ...... has been credited to the Government under the head of account ....... Signature ......... Dated .........] Designation .......
