Application Number: INS-20-229973(31/12/2020)

Note: 1. This form may be kept for future reference only.

APPLICATION TO ATOMIC ENERGY REGULATORY BOARD (AERB) FOR APPROVAL OF

INSTITUTE REGISTRATION

Application Number : INS-20-229973

Date of Application : 31/12/2020

Institute Details:
Institute Name : SPAN ENGINEERING WORKS
Institute Type : Private
Registered with any State/Central Govt auth. : Yes
Provide Certificate No. : 27ABEFS0669J1ZU
PAN No. : ABEFS0669J
TAN No. :

Institution Address:
Address Line 1 : PLOT NO 139 INDUSTRIAL ESTATE PALUS
Address Line 2 : SANGLI
Landmark :
State : Maharashtra
City/District : Sangli
PIN : 416310

Address of Communication:
Address Line 1 : PLOT NO 139 INDUSTRIAL ESTATE PALUS
Address Line 2 : SANGLI
Landmark :
State : Maharashtra
City/District : Sangli
PIN : 416310

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 Application Number: INS-20-229973(31/12/2020)

Contact Details:
Phone (O) : 02346 226199
Email (O) : span.engg@yahoo.com
FAX :
Website : https://:www.spanengg.in

Type of Facility:
Practice : Consumer Products and Scanning Facility
Type of Facility : End User - Consumer Products and Scanning Facility

Employer Details:
Personal Details:
Title : Mr.
First Name : DHANANJAY
Middle Name : SURESH
Last Name : PATIL
Designation : CHIEF EXECUTIVE
Date Of Birth : 10/06/1987
Gender : Male
Document/card for proof of identity and date of : PAN card issued by Income Tax Department
birth
Document/card No. : BEYPP4818J
Aadhaar No. : 314373340083

Residential Address:
Address Line 1 : SO SURESH DNYANDEO PATIL
Address Line 2 : VIDHYA NAGAR PALUS SANGLI
Landmark :
State : Maharashtra
City/District : Sangli
PIN : 416310

Permanent Address:
Address Line 1 : SO SURESH DNYANDEO PATIL
Address Line 2 : VIDHYA NAGAR PALUS SANGLI
Landmark :
State : Maharashtra
City/District : Sangli

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 Application Number: INS-20-229973(31/12/2020)

PIN : 416310

Contact Details:
Phone (O) : 02346 226199
Phone (R) : 099 21917111
Email (O) : span.engg@yahoo.com
(This email id will be considered as 'Registered email id')
Mobile(+91) : 9921917111

Attachment Description File Name

Proof of identity and date of birth : PAN Card of Chief Executive.pdf
Proof of employership : Employers Details.pdf
Photo copy of PAN No Of institute : PAN CARD - Company.pdf
Photo of TAN No Of institute :
Photo of Adhar No Of employer : Aadhar Card of chief executive.pdf
Photo of Government Certificate : GST Certificate.pdf
Authentication letter for E-mail Id and Mobile No. : UNDERTAKING.pdf
:

With respect to the application for the ‘Application Number’ mentioned above, I hereby certify that,
all the statements made in the application are correct to the best of my knowledge and belief.

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