Letter of Undertaking

To

The Hon. Secretary

IMAGE [IMA Goes Eco friendly] – IMA KSB
IMA State Headquarters, Anayara – P.O.,
Thiruvananthapuram – 695029

Subject: Letter of Undertaking by ‘Segregation In-Charge’ of the Healthcare Institution (HCI)

DR SHAHIN SAINUDEN
I Mr. / Mrs. ………………………………….………………….
.

hereby declare that I am the

v
MBBS
original certificate holder of ………………………………(Medical/Nursing/Paramedical
TCMC MODERN MEDICINE
Degree or Diploma) under …………………………………………….
-

(System of Medicine)
75/35
with…………………………………………….(Reg. No.) and I am currently working at
FHC-PALLICKAL (On LSGD contract)
…………………………………………….…............……. (Name of healthcare institution)
MEDICAL OFFICER
as …………………………….…........…………….(Designation).

I also declare that:

1. I have read & understood the "Biomedical Waste Management Rules, 2016" and
CPCB Guidelines for handling COVID -19 biomedical waste;
-

2. I shall be responsible for the segregation of the biomedical waste generated in this
institution.
3. I shall be responsible for the improper segregation, if any detected from this Healthcare
Institution;
4. I shall inform IMAGE once I relieve from the responsibility of the ‘segregation in-

Atta
charge’ of this HCI.
5. I have submitted Self-attested copy of valid ID Card
[Aadhaar/Driving Licence/Passport/PAN Card]

I hereby declare that the above furnished details are true to the best of my knowledge and
belief.

S
De

GlM
ad
I have read and agree to the Terms and Conditions as the ‘Segregation In-charge’ of this
Healthcare Institution.

Place: SOORANAD Name: DR .

SHAHIN SAINUDEEN
Date: 06-09-2023 Signature:
Salin
-
Mobile No: 9961799535

(Official Seal of the HCI)