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Biological Waste Service Request Form
Organization Details
Organization name*
Capacity:*   Clinic.
  Bed (for Hospitals)..
City or Zone* District
Mail Box* Postal Code
Telephone no.* Fax no.*
E-mail
MOH License Number* Commercial Registration*
Person in Charge Information:
Person in charge* Job Title:*
Extension no. Mobile no.*
E-mail*
Service Details :
The requested service:*
* Requeired fields