Schedule | Reg 4 |

To the Minister of Health Take notice that I, ...... of ....... hereby appeal under section 23 of the Radiation Protection Act 1965 against the decision of the Director-General of Health conveyed to me by letter dated the...... day of...... 19.... I make my appeal on the following grounds:...... And I hereby appoint...... of...... as assessor on my behalf for the purposes of this appeal. Dated at...... this...... day of...... 19.... Signature of Appellant:...... I hereby consent to act as assessor for the purposes of this appeal. Signature of Assessor:.......