Form B

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ORIGINAL/DUPLICATE FOR DISPLAY

FORM B
[See Rules 6(2), 6(5) and 8(2)]

CERTIFICATE OF REGISTRATION
(To be issued in duplicate)

1. In exercise of the powers conferred under Section 19 (1) of the Pre-natal Diagnostic
Techniques (Regulation and Prevention of Misuse) Act, 1994 (57 of 1994), the
Appropriate Authority ………………….. hereby grants registration to the Genetic
Counselling Centre*/Genetic Laboratory*/Genetic Clinic*/Ultrasound Clinic*/Imaging
Centre* named below for purposes of carrying out Genetic Counselling/Pre-natal
Diagnostic Procedures*/Pre-natal Diagnostic Tests/ultrasonography under the aforesaid
Act for a period of five years ending on …………….

2. This registration is granted subject to the aforesaid Act and Rules thereunder and any
contravention thereof shall result in suspension or cancellation of this Certificate of
Registration before the expiry of the said period of five years apart from prosecution.

A. Name and address of the Genetic Counselling


Centre*/ Genetic Laboratory*/ Genetic Clinic*/
Ultrasound Clinic*/ Imaging Centre*.
B. Pre-natal diagnostic procedures* approved for
(Genetic Clinic).
Non-Invasive
(i) Ultrasound
Invasive
(ii) Amniocentesis
(iii) Chorionic villi biopsy
(iv) Foetoscopy
(v) Foetal skin or organ biopsy
(vi) Cordocentesis
(vii) Any other (specify)
C. Pre-natal diagnostic tests* approved (for Genetic
Laboratory)
(i) Chromosomal studies
(ii) Biochemical studies
(iii) Molecular studies
D. Any other purpose (please specify)

3. Model and make of equipments being used (any change


is to be intimated to the Appropriate Authority under
rule 13).

4. Registration No. allotted

5. Period of validity of earlier Certificate of Registration.


(For renewed Certificate of Registration only) From ………. To ……….

Signature, name and designation of


The Appropriate Authority
Date:

SEAL

DISPLAY ONE COPY OF THIS CERTIFICATE AT A CONSPICUOUS PLACE AT THE


PLACE OF BUSINESS

*Strike out whichever is not applicable or necessary.

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