No.: Date: www.bioneeds.in REQUEST FORM – BIOANALYTICAL ASSAY (for Ligand binding assays, Quantification assays, Immunogenicity Particulars Details Product Name Manufacturer/supplier ( Mandatory : e mail ID and Phone number ) Batch No. Date of Manufacture Date of Expiry CoA of the product ( provide as supplement) Method of analysis Yes No Method Development requirement Yes No Supply of Critical reagents ( antibodies/ conjugates /others ) Validation guideline (USFDA/EMA/others) Yes No Availability of Method Specify if any commercial kit to be used Number of samples for analysis Additional information ( if any) 1|Page Requested by: Date: Address for Correspondence : BIONEEDS, “Siddhi Siri Veera Sadana”, 6th Cross, Ashok Nagar, Tumkur – 572 102, Karnataka, Mob: 09844457677, Phone: 0816-2243751-55, Fax: 0816-2243333 Address of facility : BIONEEDS, Devarahosahally, Sompura Hobali, Nelamangala Taluk, Bangalore Rural District, Karnataka, INDIA, Email: bd@bioneeds.in 2|Page