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["[별지 제1호 서식]"]
[]
[{"$nulls":8},"접수번호"]
["방사성물질 안전제품 인증 신청서"]
["회사\n정보","상\n호","신청업체",null,null,null,"사업자등록번호"]
[null,null,"대표자",null,null,null,"TEL",null,null,"FAX"]
[null,null,"담당자",null,null,null,"휴대전화",null,null,"E-mail"]
[null,"주\n소","본사","(          )"]
[null,null,"생산지","(          )"]
[null,"기업유형",{"$nulls":4},"설립일"]
[null,"회사인원",null,"(명)",null,null,"매출액",null,null,"공장규모","(m2)"]
["제품\n정보","제품명",{"$nulls":4},"모델명"]
[null,"제조방식"]
[null,"판매방식"]
[null,"제품종류"]
[null,"인증용도"]
[null,"생산량",null,"_______________ 개/년",null,null,"제품 매출액",null,"_____________________ 백만원/년"]
["신청인증",{"$nulls":6},"신청 유형"]
["시험\n샘플\n정보","번호",null,"측정 시료명",null,null,null,"시료수",null,"비고"]
[null,1]
[null,2]
[null,3]
[null,4]
["[개인정보 수집·이용 동의서]"]
["개인정보 수집 및 이용목적 : 방사성물질 제품안전 인증신청 접수 및 인증기업 정보 관리"]
["수집하려는 개인정보의 항목 : 인증추진 담당자 성명, 전화, 핸드폰, 이메일"]
["개인정보 보유 및 이용 기간 : 1년"]
["※ 신청인은 이에 대한 동의를 거부할 수 있으며, 동의가 없을 경우 인증 신청이 제한됩니다."]
["※ 개인정보는 다른 용도로 활용하지 않으며 안전하게 보호됩니다."]
[]
["위와 같이 방사성물질 안전제품 인증을 신청합니다."]
["년        월        일 "]
[{"$nulls":7},"신청기업명"]
[{"$nulls":7},"대   표   자",null,"     (인)"]
["KOTITI시험연구원장 귀하"]