Online Medical/Clinical Waste Disposal form

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



Disposal type: Medical_below_15    Medical_16_to_25    Medical_26_to_50    Medical_51_to_100    Medical_101_to_150    Clinical
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.20000 * Cli_Waste Rs.7000 * Medical_16_to_25 Rs.25000 * Medical_26_to_50 Rs.30000 *
Medical_51_to_100 Rs.60000 * Medical_101_to_150 Rs.75000 *
Form Number:-