KI Biobank
Sample Withdrawal Order
N.B. It is important to fill in the Sample withdrawal order and post it to KI Biobank sample
withdrawal coordinator in good time to your planned analyses.
Customer details
Karolinska Institutet
Other organisation
Department:
Orderer:
Phone number:
E-mail address:
Sample collection details
Sample collection (study)
to withdraw samples from:
Principal investigator of
sample collection:
Contract ID of the original
agreement:
Ethical approval Dnr:
Sample information
Type of samples to
withdraw:
(Please select only one
sample type per order, e.g.
create one withdrawal order
for each sample type.)
DNA from Blood
CSF
DNA from Saliva
Saliva
Blood
Urine
Serum
Other,
please specify:
Plasma
Total number of samples
to withdraw:
1
Blankettnamn: Sample Withdrawal Order
Gäller from:2011-04-29
Dok.nr.-utgåva:0360-3
KI Biobank
Sample Withdrawal Order
DNA samples
To calculate which sample volume to withdraw, please use the following formula:
Required Amount (ng)/Sample Concentration (ng/µl) = Sample Volume (µl)
DNA normalization = dilution of all samples to the same concentration in 96 well format.
Note that all DNA samples in a study must be normalized to the same selected
concentration.
Choose format for the normalized DNA:
Abgene 1.2 ml 2D tubes (required for storage at KI Biobank)

to concentration: ………. ng/µl (20-100 ng/µl)

to volume: ………. µl (200-500 µl)

maximum volume to transfer from stock samples ………. µl (200-500 µl)
Abgene 0.8 ml Deep well plate (only for direct delivery)

to concentration: ………. ng/µl (20-100 ng/µl)

to volume: ………. µl (200-500 µl)

maximum volume to transfer from stock samples ………. µl (200-500 µl)
Normalized DNA delivery on Abgene PCR plate
Sample volume:………… µl (5-170 µl)
Please select plate layout:
Empty wells at the end of the plate, No ………. (0 = 96 samples per plate)
Randomly placed empty wells, select: 2 / 4 / 6
Two randomly placed duplicate samples and 4 randomly placed empty wells
Stock DNA delivery on Abgene PCR plate:
Sample volume:………… µl (5-170 µl)
Please select plate layout:
Empty wells at the end of the plate, No ………. (0 = 96 samples per plate)
Randomly placed empty wells, select: 2 / 4 / 6
2
Blankettnamn: Sample Withdrawal Order
Gäller from:2011-04-29
Dok.nr.-utgåva:0360-3
KI Biobank
Sample Withdrawal Order
Other sample types
Tubes
Other format, please specify:
Save one aliquot per sample donor at KI Biobank
(Note that if you don’t tick this box, you may not have any aliquots left for some samples
donors after this withdrawal.)
Donor identity
CDK list file format
Excel
(CDK=Customer donor key,
id of the donor within the
study)
Other, please specify:
Delivery details
Name and complete
address of receiving
department/
organisation:
Phone:
Contact person:
E-mail:
Invoice address (including
ZZ-reference code within
KI):
Will the samples be sent
to a laboratory outside
Karolinska Institutet?
Yes
No
3
Blankettnamn: Sample Withdrawal Order
Gäller from:2011-04-29
Dok.nr.-utgåva:0360-3
KI Biobank
Sample Withdrawal Order
Note that a Material Transfer Agreement (MTA) between the legal partners is needed for
samples that will be sent for analysis outside Karolinska Institutet. MTA needs to be filled in,
signed by recipient laboratory and returned to KI Biobank before sample delivery. The MTA
template is provided by KI Biobank sample withdrawal coordinator.
This agreement is a mutual understanding between the principal investigator of the sample
collection and the project leader to use requested samples as specified in the ethical approval.
Signature
Date:
Signature of principal
investigator:
Clarification of signature:
4
Blankettnamn: Sample Withdrawal Order
Gäller from:2011-04-29
Dok.nr.-utgåva:0360-3