Declaration
I Dr……………………………………………………… son / daughter / wife of……………………………
aged……….years resident of …………………………………………….working ………….. as
(Designation……………………………………….in (CE Name TIRUPATI HEALTHCARE Diagnostic
Techniques (Regulation and Prevention of Misuse) Act 1994(57 of 1994) 2 and the Pre –natal
Diagnostic Techniques (Regulation and Prevention of Misuse) Rules 1996 3.
I also undertake to explain the said Act and Rules to all employees of the Genetic Counselling
Centre/ Genetic Laboratory/ Genetic Clinic/ Ultrasound Clinic/ IMAGING Center in respect of
which registration is sought and to ensure that Act and Rules are fully complied with .
Date Signature …………………………………………………
Regd . No…………………………………………………