HEADSHIP OF TEST AND CALIBRATION CENTER
TEST REQUEST FORM
CUSTOMER INFORMATION :
Application Date:
Contact person:
Phone:
Fax:
e-mail:
Address:
(If there is) Protocol-Aggreement Number-
Tax Department/No:
Name/Title of the Company-Organization:
Date:
Address that report will be sent: (please write if different)
Requested Laboratory:
Item No
Detailed Description of the Sample
(Sort, Brand, Type, Species, Model etc. Declaration number when
needed)
Sample
Amount
Test Fee and Evaluation
Tests/ Standard Number-Date
(This part will be filled by related laboratory)
(if specified in agreement)Discount Rate/Amount
Total Test Fee (VAT Included):
Additional demands requested in the report :
Accreditation Logo*
Comment
General Conditions:
1. Sampling conforming to the test conditions is under the responsibility of the customer when the sample is not taken by the laboratory
Measurement Uncertainty 2. Transportation, packaging and conservation of the sample(s) are under the responsibility of the customer until the sample is accepted by the
laboratory.
Report in English (please ask.) 3. Acceptation of Request starts at the date after the essential papers and documents are handed in to the laboratory
completely.
4. Technical documents related to the product (excluding standards) will be sent by the customer together with the sample.
5. When deviation occurs from the committed conditions, customer is informed by written or verbal declaration, or via our
web-page.*
6. Objection period is 1 month from the beginning of result declaration date. Samples which are not taken in 3 months after the procedures
are completed, are discharged. When needed, discharge procedure costs are covered by the customer.
7. If samples are sent by Transportation Company (cargo etc.), Sample Acceptation Form is not given.
8. In the condition that the samples are not handed in to the laboratory within 30 days after test request date, test request is
cancelled.
9. Tests are not started before receipt of payment of the test fee is handed in to the laboratory.
10. In the condition that the receipt of payment is not handed in to the laboratory within 30 days after test request date, test
request is cancelled and samples are liquidated.
11. In case of dispute, Courts in Ankara and Enforcement Offices are authorized.
Prepared by
(Signature)
(Name-Surname)
Subsupplier Name/Address: (This part will be filled by laboratory if test will be done by subsupplier )
Customer Confirmation:
We declare that we accept requested tests to be performed in
conditions indicated in this form and to pay the receipt that will be
invoiced to us for this service. We agree and confirm the specified
conditions. It is our responsibility for all the losses and damages
resulted due to insufficient and wrong information declared by us
above.
Confirming Authorized Person:
(Name-Surname-Seal)
Date
Signature:
:
Below information will be filled by related laboratory:
Test Request Approval
(Director of the Lab.)
(Name-Surname)
(Signature)
Request
Acceptance
Date
Request Transferred
Test
Starting Date
Request No
Division Code
Department
Head(paraph)
Estimated End Date
Test Personnel
* Please visit our web-page for contact information, detailed information about our services, and following up your test request status.
http://www.tse.org.tr/hizmetlerimiz/deney-hizmetleri
LAB-D-FR-03/15.08.2014-0