Application Number: RPR-23-87791(10/09/2023)

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

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

RADIATION PROFESSIONAL

Application Number : RPR-23-87791

Date of Application : 10/09/2023

Personal Details:
Name : Mr. VISHAL VITTHAL SAWANT
Date Of Birth : 11/12/1996
Practice : Industrial Radiography
Professional Role : Radiographer
Gender : Male
Identification Type : Driving License issued by RTO
Identification No. : MH4220170002997
Aadhar No. : 788230812276

Residential Address:
Residential Address : SERVE NO 43 INDAPUR KALAMB PUNE
Landmark :
State : Maharashtra
City/District : Pune
PIN : 413114

Permanent Address:
Permanent Address : SERVE NO 43 INDAPUR KALAMB PUNE .
Landmark :
State : Maharashtra
City/District : Pune
PIN : 413114

Contact Details:
PhoneNo(R) : -
MobileNo (Permanent) : 9607619596
Email (Permanent) : vishalsawant111296@gmail.com

Basic Education Details:

Course Name Year Of Passing Institution Name Board/University Subjects
10+2 (Science) 2015 shree wardhman maharashtra state science
vidyalaya & JR board
college
walchandnagar

Page 1 of 2
 Application Number: RPR-23-87791(10/09/2023)

Professional Education Details:

Course Name Year Of Passing Institution Name Board/University Subjects
Radiographers 2022 quality NDT training BARC radiation safety
Certification Course institute pune

Internship/Experience Details:
Category Role Institution Name Start Date End Date
Experience apprentice walchandnagar 01/06/2015 30/06/2018
industries limited

Attachment Description File Name

Your Photograph photo_page-0001.jpg
Proof of Identity and Date Of Birth adddar card.pdf
10+2 (Science) HSC.pdf
Radiographers Certification Course Level 1.pdf
Experience Experience.pdf

radiation safety Level 1.pdf

Experience Certifica Experience.pdf

I Acknowledge that:

• RP (Radiation Professional) registration is one time process.

• I have never obtained RP registration through eLORA.
• There are options available in eLORA home page for forgot user id and forgot password.
• Multiple RP registration is not allowed by AERB.
• In case, AERB finds multiple RP registration of mine in eLORA, appropriate regulatory action may be
initiated against me.

I hereby undertake that all the particulars provided in the application are correct to the best of my knowledge and
belief.

Page 2 of 2