Application form for renewal of Registration of a Genetic Counselling Center / Genetic Laboratory / Genetic Clinic / Ultrasound Clinic / Imaging Center - Form A

Service Details are:

 
Service is defined by the - LINE DEPARTMENT - Directorate Of Health Services Family Welfare

The Beneficiary of this service will be Business persons ( G2B )

Types of Service:
Regulatory
(Regulatory Services are those which can be denied by the government)

Do applicant(s) need to register to avail this service?
Yes
The URL at which more information about service are available :
eodb.assam.gov.in
No of Days within which service will be delivered after application submission?
NA          

Note: The time period given is excluding the Government holiday list

Who can apply for this Service?

 
The Application can be submitted by the following:
Institution

How to submit application and Enclosure Details?

  The Application can be submitted by the following:
Online


Following Documents are required along with the application form

Enclosure Type
Type Of Enclosure Original / Photocopy Attestation Required Documents Recommended
A copy of sketch map of the clinic. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic   
A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.   
UBIN Certificate Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate   
Common Application Form (Department of Industries and Commerce) Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form   
Declaration of Proprietor/Partner/Director etc in affidavit Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit   
Declaration of Proprietor/Partner/Director etc in affidavit Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit   
A copy of sketch map of the clinic. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic   
A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.   
UBIN Certificate Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate   
Common Application Form (Department of Industries and Commerce) Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form   
A copy of sketch map of the clinic. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic   
A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.   
UBIN Certificate Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate   
Common Application Form (Department of Industries and Commerce) Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form   
Declaration of Proprietor/Partner/Director etc in affidavit Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit   
A copy of sketch map of the clinic. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic   
A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.   
UBIN Certificate Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate   
Common Application Form (Department of Industries and Commerce) Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form   
Declaration of Proprietor/Partner/Director etc in affidavit Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit   
A copy of sketch map of the clinic. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic    A copy of sketch map of the clinic   
A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine. Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.    A copy of certificate of degree and appointment letter mentioning the name of Radiologist/Gynaecologist/Sonologist who will operate USG machine.   
UBIN Certificate Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate    Copy of UBIN (Unique Business Identification Number) Certificate   
Common Application Form (Department of Industries and Commerce) Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form    Copy of Common Application Form   
Declaration of Proprietor/Partner/Director etc in affidavit Original Original Original Original Original Not Required Not Required Not Required Not Required Not Required Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit    Declaration of Proprietor/Partner/Director etc in affidavit   

Pre-defined format/template
Document Name Prescribed Format
Application Form (Sign and Upload) view



What will Applicant get as Service Deliverable?

  The applicant will receive Output Certificate/Report as the service deliverable(s).
Certificate/Report