APPLICATION FORM FOR RPL SERVICE

Application Form Number:AOA 101

Company/Agency Name:

Address:

Tel:

Fax NO:

Email*:

Start Using On (dd/mm/yy) *:

Type of Application:  New Application  Additional

Type of system X, β, γ

Full Name IC Number (New) Position
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Officer in Charge:

Terms and Conditions

1. The RPL Badge: F.O.C. on a loan basis, the badge belongs to APM NUCLEAR TECHNOLOGY SDN BHD

2. Registration Fees:
– The Current RPL Dosimeter user: F.O.C
– New and additional user: F.O.C

3. The Analysis fee service: RM 17.50 per person/month

4. The penalty for the lost RPL Dosimeter: RM 150.00/badge

5. Postage charge for RPL Dosimeter using Poslaju Courier :

NO QUANTITY PRICE (RM)
PENINSULAR SARAWAK SABAH
1 Less than 20 PCS 8.00 16.00 16.00
2 21 PCS – 40 PCS 11.50 22.00 22.00
3 41 PCS – 60 PCS 15.00 28.00 28.00
4 61 PCS – 80 PCS 19.00 40.00 40.00
5 81 PCS – 100 PCS 22.00 50.00 50.00
6 Additional every 20 PCS +3.00 +7.00 +7.00

 I Agree to the Terms and Conditions

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