A-1 Form

APPLICATION FOR ORDERING RADIOACTIVE MATERIAL

(Primary Isotopes,Radiochemicals,Radioppharmaceuticals,Labelled Compounds etc.)
Customer Code :

Name & Full address of Applicant: 2. To be Invoiced to:

Name Name
Designation Designation
Department Department
Institution Institution
Address Address

City with pin City with pin

Phone Fax : Phone Fax :

E-Mail E-Mail
3. Primary Isotopes,Radiochemicals,Radioppharmaceuticals,Labelled Compounds etc. (See note 5)
a) Radioisotope : b) Code : c) Quantity/Activity: d) Specific Activity:
e) Half-Life: f) Any further Information if not covered by code :
4. Type of operation envisaged using the radioisotope ( tick the appropriate box )
a) Simple wet b) Complex wet c) Simple dry d) Dry & dusty
5. Information for verifying AERB/BARC authorization quantity:
a) Is the applicant authorized by AERB/BARC to receive and use the above products: Yes / No
b) If yes, maximum activity authorized and its reference:
c) Quantity of the radioisotope in stock on the required date:
(item (c) relevant for radioisotopes with half-life more than 30 days)
6. Purpose of Use (tick the appropriate box)
a) On humans b) Investigation on animals c) Research d) Others
i) Oral ii) Injection iii) In vitro

7. Delivery Instructions: Material is required on __________ Per. Collection/ by Air. Airport: ____________________
8. Remarks if any:

9. If this application is accepted by BRIT it is to be 10. I undertake to ensure any material supplied against this
registered as a purchase order for the material to which it application will not be used otherwise than described above.
refers subject to the conditions of Sale listed overleaf. I undertake full responsibility when the material is used on
human beings. I have read the explanatory notes and
conditions of sale given overleaf.
Signature of person Signature of applicant
authorised to sign the
Purchase Order on behalf of __________________ Designation __________________
the above institution Date : Date :

Name, Designation & Name , Designation &

Seal of office Seal of Office

Purchase Order No & Date :

For Office use only
Our Reference
IGA/
1. Payment received details :
2. Passed on to _______________________ for further action
For Customer Support Services Cell
(for Explanatory notes please see on the reverse side)
V N Purav Marg, Mumbai 400 094 ; Tel: 25573534, 2556 5535, 25574363 Mobile 9869454120/30 Fax: 91 22 2556 2161, 2558 1319
e-mail: sales@britatom.gov.in Website : http://www.britatom.gov.in
 I. EXPLANATORY NOTES

1. The applicant is the person who is authorised to procure radioactive material by Atomic Energy Regulatory Board
and will be in charge of the use, storage and responsible for making arrangement for the disposal of the radioactive
material. Despatch advice indicating the date of despatch of consignment will be sent to the consignee and the
consignee should arrange prompt collection of the consignment & confirm the same to BRIT.

2. The consignee’s copy of the air consignment note is usually carried by the Airline along with the consignment itself
and users are advised to arrange collection of the consignment from the airline office on the basis of the despatch
advice/intimation sent by us.

3. Application should be complete in all respects. The code and the name of the product should be invariably specified.
Incomplete and incorrect applications are liable to be returned to the applicant for corrections.

4. Indicate the specific activity in millicuries per gram of activated element, or specify ‘carrier-free’ as applicable.
In case of carbon-14 and tritium labeled compounds, indicate the specific activity in millicurie per millimole.

5. Ever effort will be made to supply the products on the scheduled dates. In exceptional cases we may be constrained
to postpone / cancel the supply on account of unforeseen reactor shutdown or due to any unforeseen situation
beyond our control.

6. Order for sealed radiation sources in A/3 form, for Radiography sources in R/1 form, for labeled Biomolecules in
B/1 form standing order for Radiopharmaceuticals in SA-4 form and for Neutron irradiation A/2 form.

7. Telephonic / Fax orders and orders by letter will not be entertained. Under very special circumstances advance
intimation may be given by telephone / fax and this should be followed by the application in A-1 form.

CONDITIONS OF SALE

1. The radioactive material supplied against this application must not be sold or transferred to any other user or
otherwise disposed off except as advised by AERB/BARC.

2. Facilities for the safe storage, handling and use of the material prescribed by AERB/BARC from time to time
must be provided.

3. Material supplied against this application will be charged for according to prices currently in vogue. Packing
and freight charges will be invoiced in addition. On receipt of the corresponding invoice by the invoice
(column 2), payment if any, is to be made by crossed DD drawn on State Bank of India or any Mumbai branch
of a scheduled bank in favour of Accounts Officer, BRIT and sent to Accounts Officer, BRIT, V N Purav
Marg, Mumbai 400 094. Please note that cheques are not acceptable and all users should make payment by DD.

4. Lead containers used in packing of radioactive materials and classified as returnable are to be returned, freight
paid to CSSC, BRIT, V N Purav Marg, Mumbai 400 094.

5. Any complaint or discrepancy observed should be brought to our notice within two days of the receipt of the
consignment.

6. Cancellation of the order already placed should be made at least 7 days in advance of the scheduled date of
supply.

7. The terms and conditions of supply stated above only will apply. We will not be bound by terms and conditions
stipulated by the applicant.

V N Purav Marg, Mumbai 400 094 ; Tel: 25573534, 25565535, 25574363 Mobile 9869454120/30 Fax: 91 22 2556 2161, 2558 1319
e-mail: sales@britatom.gov.in Website : http://www.britatom.gov.in