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REGISTRATION FORM
PROFICIENCY TESTING PROGRAM
MAY 2015
1.
2.
3.
4.
Laboratory name: ...........................................................................................................................
Company name: .............................................................................................................................
Contact person: ................................................................. Title: ....................................................
Address: ..........................................................................................................................................
.........................................................................................................................................................
5. E-mail: ............................................................................................................................................
6. Telephone number:............................................................ Fax :....................................................
7. Address for sample delivery (if different to section 4): .................................................................
.........................................................................................................................................................
8. Telephone number:............................................................ Fax :....................................................
9. Payment method:
By cash;
Bank transfer;
Request for invoice first
10. Information in invoice:
Tax code ..........................................................................................................................................
Company name (if different to section 2): ......................................................................................
.........................................................................................................................................................
Address (if different to section 4): ..................................................................................................
.........................................................................................................................................................
11. We apply to participate in the PT programs in 2015 organized by QUATEST 3 (according to
official dispatch no.069/KT3-KT), as follows:
QPT 06/15 – Milk 15E15
QPT 22/15 – Water 15B15
QPT 07/15 – Feed 15A15
QPT 23/15 – Vegetable 15A15
Notes:
- In QPT 06/15 and QPT 07/15, participants are requested to report in CFU/g unit.
- Participants need to provide exact information in section 1 - 11 (that will be used during a PT program,
when delivering PT samples, inform PT results, make payment …).
- QUATEST 3 will only announce the results + codes of lab via email provided in section 5 by the participants.
- This is an official registration form, please sign and stamp and tick off the characteristics in the registration
form before sending it to QUATEST 3.
- Fee include VAT (5 %) but do not include of delivery fee to overseas.
Date:…./…./201…
REPRESENTATIVE OF COMPANY
(Full name/Title)
LABORATORY
(Full name/Title)
…………………………
………………………………
Please send Registration form via fax, email or by post to the following address: no later than April 15th, 2015
Mai Nha Uyen - Proficiency Testing Provider Unit
Quality Assurance and Testing Center 3
No. 7, Road 1, Bien Hoa Industrial Zone 1, Dong Nai province, Vietnam
Tel: (84-61) 383 6212 - Ext: 123 - Fax: (84-61) 882 6917 / 383 6298
E-mail: [email protected]
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REGISTRATION FORM
PROFICIENCY TESTING PROGRAM
MAY 2015
Name of PT
program
Name of
sample
Microbiology
in milk
powder
Milk
15E15
Enumeration of
Enterobacteriaceae
(CFU/g)
01 sample/lab
Approx. size:
10 g
2.000.000 đ/lab
x “number of
lab”
Feed
15A15
Enumeration of
Escherichia coli (CFU/g)
01 sample/lab
Approx. size:
10 g
2.000.000 đ/lab
x “number of
lab”
Water
15B15
Lead (Pb) content
(µg/L)
Cadmium (Cd) content
(µg/L)
Arsenic (As) content
(µg/L)
Mercury (Hg) content
(µg/L)
01 sample/lab
Approx. size:
250 mL
3.000.000 đ/lab
x “number of
lab”
Nitrate content (mg/kg)
01 sample/lab
Approx. size:
100 g
2.500.000 đ/lab
x “number of
lab”
QPT 06/15
Microbiology
in feed
QPT 07/15
Water
QPT 22/15
Vegetable
QPT 23/15
Vegetable
15A15
Characteristics
Number of
sample
Number
of lab
Fee
(VNĐ)
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registration form proficiency testing program may 2015