21 st CORROSION AWARENESS AWARDS 2015
Application Form
Excellent Public / Private Sector Laboratory
Section
Details Sheets Remarks
(to be filled in by NIGIS)
Applicant's Letter
A
NIGIS Form - General Particulars
Applicant's Essential Enclosures
A 01 Proof of Registration / Incorporation of Laboratory
B
A 02 Recommendation Letters
A 03 Resume (max 300 words)
NIGIS Form - Confidential (to be filled in by the authorized person without mentioning name of Laboratory anywhere in this Form)
B 1 Objectives
B 2 Technical Competence
B 2.1
Certification / Approval of Laboratory / Tests
B 2.2
Manpower / Equipment & Facilities
B 3 Experience - Last 5 years
B 3.1
Test Conducted and Research Projects carried out
B 4 Publications & Special Contributions (Last 5 years)
B 5 Corrosion Awareness/Promotion Activities or Awards
(Last 5 years)
B 5.1
Memberships of Corrosion Institutions /Societies
B 5.2
Participation in Corrosion related Conferences / Seminars/Events
B 5.3
Awards for Contributions to Field of Corrosion / etc.
B
Applicant's Enclosures (with Enclosure Nos. written on all pages and Applicant 's name written only on top of first page of
Enclosure)
B 2.1
B 01 Copy of Certificate of Certifying / Approving Authority
B 2.2
B 02 List of Test Equipment / Facilities
B 3.1
B 03 List of Test and Projects carried out
B 4 B 04 List of Publications
B 4 B 05 List of Technical Research Contributions
B 5.1
B 06 List of Membership of Corrosion Institutions /
Societies
B 5.2
B 07 List of Corrosion Conferences / Seminars
Participated
B 5.3
B 08 List of Awards received for Contribution to Field of
Corrosion

21 st CORROSION AWARENESS AWARDS 2015
Application Form
Excellent Public / Private Sector Laboratory
Application No. (To be filled by NIGIS) ............................
1.
2.
AWARD APPLIED FOR
GENERAL
Name of Laboratory
Laboratory
Address
Person Submitting
Application
Name
Designation
Address
Preferred Address for
Communication
Date of registration /
Incorporation
Public / Private
City
Pin:
Phone
Mobile
Email
City
Pin:
Phone
Mobile:
Email:
Lab Person
State
Fax
State
Fax
3. ESSENTIAL ENCLOSURES
A-01 - Proof of
Registration / Incorp
A-02 - Recommendation
Letters
A-03 - Resume
(max 300 words)
Enclosed Yes No
I confirm that all information given and enclosed is true to best of my knowledge.
Signature Date

21 st CORROSION AWARENESS AWARDS 2015
Application Form
SECTION - B: CONFIDENTIAL PARTICULARS
(To be filled in by applicant without mentioning his / her name anywhere)
1. OBJECTIVES (According to Memorandum / Articles of Establishment of Laboratory)
SN
1
2
3
4
5
6
Monitoring, Testing , Evaluation of performance and quality of materials
Research and Development related to
Objective-1 & Corrosion Control
2. TECHNICAL COMPETENCE
2.1 Certifications / Approvals of Laboratory / Tests
SN Main Tests Standard
Certified / Approved by
International
Authority
National
Authority
1
2
3
4
5
6

4
5
6
2.2 Manpower / Equipment & Facilities
Key Personnel
SN Designation Nos. Education Experience, years
Minimum Maximum Minimum Maximum
1
2
3
2. EXPERIENCE (Last 5 years)
Main Equipment
Name Make Quantity Age in years
Format for presentation of details to be given under
Enclosure B-02
SN Details
1
2
3
4
Tests listed under Section
2.1 above
Tests other than that listed under Section 2.1 above
Research & Development
Projects - Test Equip /
Procedures
- Materials
- Corrosion
- Failure Analysis
- Others
Works related to any other any Objectives
In-House Projects Public Sector Projects Private Sector Projects
Number Value, Rs Number Value, Rs Number Value, Rs

4. PUBLICATIONS & SPECIAL TECHNICAL CONTRIBUTIONS (Last 5 years)
SN
1 Books
Publications
Details
Full Books
Chapters in multi-author
Books
2 Papers Presented in
Nos.
SN Special Technical
Contributions
1
No. of
Improvements
2
No. of
Developments
Test Equip &
Procedures
Material
Performance
Corrosion
Control
Other
National Conferences
3
No. of
Indigenization Foreign Conferences
3 Papers Published in
4
National Journals /
Magazines
Foreign Journals /
Magazines
4 Awards for Papers
5
No. of
Implementation
No. of Patents
National
Others, if any
Foreign
6
5. CONTRIBUTION TO CORROSION AWARENESS / PROMOTION ACTIVITIES OR AWARDS
5.1 Membership of Corrosion Related Institutions / Societies
SN
5
6
3
4
1
2
Society / Institution
/ Organization Type
Membership
From To
Present Office Bearer
Position Since Yr
Past Positions /
Specific Contributions

5.2 Participation in Corrosion Related Conferences / Seminars / Events (Last 5 years)
SN Conference /
Seminar / Event
No. of conferences / Seminar / Events participated during the last 5 years as
Sponsor Organizer Invited Guest Invited Speaker Author Delegate
1 NIGIS- CORCON
2 NACE International
3
4
5
6
5.3 Awards for Contributions to Field of Corrosion & Corrosion Awareness Promotion (Last 5 Years)
SN Society / Institution /
Organization
Year Event & Place Name of Award
1
2
3
4
5
6