9/18/2017 Register Radiation Professional

APPLICATION FOR REGISTRATION OF RADIATION PROFESSIONAL

Personal Details Educational Details Attachment

Please Upload attachment for Experience in 'Proof of Education/Internship/Experience'

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Please Upload attachment for Experience in 'Proof of Education/Internship/Experience'
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Your file For Row1 is of type that's not allowed application/octet-stream (Tab:Attachments)
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Please Upload attachment for Certification by BARC as Site-In-Charge in 'Proof of
Education/Internship/Experience' (Tab:Attachment)
Please Upload attachment for Training Course in Industrial Radiography and Safety Aspects (IRG-1) in
'Proof of Education/Internship/Experience' (Tab:Attachment)

All fields marked by *are mandatory

Personal Details

Title* Mr.
* BHASKAR
First Name
Middle Name MANOHAR

Last Name* KALE

Gender* Male
* 19/05/1975
Date of Birth
Practice* Industrial Radiography
Professional Role* Site In Charge
Document/card for proof of identity
PAN card issued by Income Tax Department
and date of birth*
* AMJPK5580G
Document/card No.
Aadhar No. 916590039881

Residential Address

Address Line1* ROW.H.NO 11

Address Line2 RAVIRAJ HUTS, TIDKE NAGAR

Landmark UNTWADI
State* Maharashtra
City/District* Nashik
PIN* 422008

Permanent Address
Is Permanent Address same as
YES
Residential Address?
Address Line1*

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9/18/2017 Register Radiation Professional

Address Line2

Landmark
State* Select
Submit Close Reset
City/District* Select
PIN*

Contact Details

Phone(R) -

Mobile No.*

Confirm Mobile No.* 9527077404

Email*

Confirm Email* bmkale@gmail.com

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