Online Medical/Clinical Waste Disposal form

1.Applicant's Name:
2.Organization Name:



Disposal type: Medical_below_15    Medical_15_to_25    Medical_26_to_50    Clinical    Medical_51_to_100
3.Address
      Village:
      Thana:
      Post:
      Dist:

4.Holding No:

5.Mobile No:

6.Details:


Application's Signature
7.Application Date: (yyyy-mm-dd)
Medical_below_15 Rs.15000 * Cli_Waste Rs.5000 * Medical_15_to_25 Rs.20000 * Medical_26_to_50 Rs.25000 * Medical_51_to_100 Rs.50000 *
Form Number:-