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European Serviced Sites CONTACT & SHIPPING INFORMATION Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 APPENDIX TABLE OF CONTENTS CONTACT INFORMATION ..................................................................................................................................... 1 PACKAGING AND TRANSPORT ............................................................................................................................ 3 COUNTRY-SPECIFIC COURIER LIST................................................................................................................ 4 DHL – PACKAGING FOR ROOM TEMPERATURE DIAGNOSTIC SPECIMENS ........................................... 5 PACKAGING THE SPECIMEN ................................................................................................................... 5 PACKING THE ROOM TEMPERATURE SHIPPER ................................................................................... 5 ADDRESSING AND DOCUMENTING THE ROOM TEMPERATURE SHIPPER ...................................... 5 DHL – TRANSPORT DOCUMENT: AIR WAYBILL FOR AMBIENT SPECIMENS ............................................... 6 DHL – PRO FORMA INVOICE FOR ROOM TEMPERATURE SPECIMENS (FOR ALL COUNTRIES THAT ARE NOT MEMBERS OF THE EUROPEAN UNION) ............................................. 7 DHL – PACKAGING FOR FROZEN DIAGNOSTIC SPECIMENS ..................................................................... 8 DHL – PACKAGING FOR FROZEN DIAGNOSTIC SPECIMENS ..................................................................... 9 DHL – SERVICE GUIDE COLLECTIONS AND FROZEN DRY ICE ............................................................... 10 DHL – PROCEDURE TO SEND FROZEN SPECIMENS - FROZEN REQUEST FORM (24)........................... 11 DHL – TRANSPORT DOCUMENT: AIR WAYBILL FOR FROZEN SPECIMENS ............................................... 12 DHL – PRO FORMA INVOICE FOR FROZEN SPECIMENS (FOR ALL COUNTRIES THAT ARE NOT MEMBERS OF THE EUROPEAN UNION) ....................................................................................... 13 QUICKSTAT – PACKAGING FOR ROOM TEMPERATURE DIAGNOSTIC SPECIMENS ........................... 14 PACKAGING THE SPECIMEN ................................................................................................................. 14 PACKING THE ROOM TEMPERATURE SHIPPER ................................................................................. 14 ADDRESSING AND DOCUMENTING THE ROOM TEMPERATURE SHIPPER .................................... 14 QUICKSTAT – PACKAGING FOR FROZEN SPECIMENS ............................................................................... 15 QUICKSTAT – PROCEDURE TO SEND FROZEN SPECIMEN ........................................................................ 16 Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 CONTACT INFORMATION CLIENT RESPONSE CENTRE Monday – Friday, 8:00 am - 6:00 pm (CET) COUNTRY TOLL FREE # CRC DIRECT AUSTRIA 0800 29 8969 +32 10 687 522 BELARUS Calling Card BELGIUM (FR) COUNTRY TOLL FREE # CRC DIRECT LEBANON Calling Card +32 10 687 535 +32 10 687 501 LITHUANIA Calling Card +32 10 687 536 0800 16 604 +32 10 687 520 LUXEMBOURG 800 22 150 +32 10 687 576 BELGIUM (DU) 0800 99 341 +32 10 687 568 MACEDONIA Calling Card +32 10 687 609 BOSNIA Calling Card +32 10 687 504 MOROCCO Calling Card +32 10 687 574 BULGARIA Calling Card +32 10 687 506 NETHERLANDS 0800 022 1707 +32 10 687 592 CROATIA Calling Card +32 10 687 509 NORWAY 800 11 408 +32 10 687 593 CZECH REPUBLIC 800 142 482 +32 10 687 512 PAKISTAN Calling Card +32 10 687 550 DENMARK 800 18 038 +32 10 687 524 POLAND 00800 321 12 25 +32 10 687 594 EGYPT Calling Card +32 10 687 604 PORTUGAL 0800 8 32 338. +32 10 687 595 ESTONIA Calling Card +32 10 687 515 ROMANIA 0800 895 108 +32 10 687 521 +32 10 687 523 FINLAND 0800 11 32 62 +32 10 687 526 RUSSIA 810 800 2013 1032 FRANCE 0800 90 75 25 +32 10 687 527 SERBIA --- +32 10 687 570 GEORGIA Calling Card +32 10 687 519 SLOVAKIA 0800 00 32 14 +32 10 687 514 GERMANY 0800 18 17 430 +32 10 687 528 SLOVENIA --- +32 10 687 537 GREECE 00800321 23 38 +32 10 687 587 SOUTH AFRICA 0800 996 802 +32 10 687 596 HUNGARY 06800 11 495 +32 10 687 588 SPAIN 900 99 3251 +32 10 687 597 ICELAND Calling Card +32 10 687 565 SWEDEN 020 79 58 56 +32 10 687 598 ILE DE LA REUNION Calling Card +32 10 687 612 SWITZERLAND 0800 55 15 47 +32 10 687 599 INDIA Calling Card +32 10 687 567 TUNISIA Calling Card +32 10 687 542 IRELAND 1 800 55 32 08 +32 10 687 589 TURKEY 00800 32 92 380 +32 10 687 543 ISRAEL 180 945 9338 +32 10 687 590 UGANDA Calling Card +32 10 68 76 06 ITALY 800 878 337 +32 10 687 591 UNITED KINGDOM 0800 89 82 95 +32 10 687 529 KENYA Calling Card +32 10 687 569 UKRAINE Calling Card +32 10 687 564 LATVIA Calling Card +32 10 687 534 E-MAIL FAX crc.europe@questdiagnostics.com +32 (0) 10 68 76 93 Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 1 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 TO RE-ORDER SUPPLIES (BY FAX) +44 (0) 208 377 3382 CENTRAL LABORATORY - SPECIMEN TO BE RETURNED TO: Quest Diagnostics Clinical Trials Unit B1, Parkway West Industrial Estate Cranford Lane - Heston, Middlesex TW5 9QA – UK PROCEDURE FOR USING CALLING CARDS TO CONTACT CENTRAL LAB (WHEN NO TOLL FREE NUMBER IS AVAILABLE) For all queries call our Client Response Centre (CRC) using the calling card provided by your monitor or with your lab supplies which will allow you to contact us free of charge. TO PHONE THE CLIENT RESPONSE CENTRE: See the contact page and dial the phone# corresponding to the country you are calling from FAX NUMBER GENERAL INQUIRIES: + 32 (0) 10 68 76 93 Please note that the card is restricted to those numbers and cannot be used for any other phone/fax number. Since you will only receive ONE CARD PER SITE please be sure to place it in a safe place, easily reachable by all the other persons that will work with you on this trial. HERE IS HOW TO PROCEED: 1. Dial the calling card toll free number for your country (list provided with the card) 2. Enter the MCI card code XXX XXX XXXX XXXX (indicated on the back of the card) 3. Dial the phone # corresponding to the country you are calling from (see Contact Information page) or + 32 (0) 10 68 76 93 (fax) Or you can also ask the operator to put you through to the requested number. Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 2 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 PACKAGING AND TRANSPORT DANGEROUS GOODS The shipment of infectious substances (such as patient's specimens with known pathogens or cultures) or other "dangerous goods" (such as certain chemicals) is subject to local, national, and international laws and regulations (or individual airlines requirements). The person(s) preparing the "dangerous goods" for shipping is/are responsible for ensuring that the package, when shipped, meets the requirements of all applicable laws (including any training requirements). The technical information presented in this manual is not intended to be, and should not be considered as, regulatory training in the handling of "dangerous goods." Any questions you may have about requirements for shipping infectious substances or other dangerous goods should be directed to appropriate consultants, counsel, or your appropriate regulatory authorities. Specimens that are transported by air must be packaged according to IATA Packing Instruction 650. For a complete description of all requirements to prepare and transport safely a consignment of specimens, please consult the current year’s Dangerous Goods Regulations (DGR) published each year by the International Air Transport Association (IATA). Among the requirements: The packaging must be of good quality capable of passing a 1.2m drop test and must consist of three components: A primary receptacle containing the specimen, A secondary packaging, and An outer packaging with suitable cushioning material. Either the primary or secondary receptacle must be capable of withstanding an internal pressure producing a pressure differential of not less than 95kPa for liquids. The package must be marked “UN3373 Biological Substance Category B.” IATA Note: Specimens shipped with carbon dioxide, solid (dry ice), or liquid nitrogen must comply with the provisions of the DGR applicable to those substances in addition to the requirements of Packing Instruction 650. Quest Diagnostics Clinical Trials purchases packaging materials from vendors who comply with the IATA 650 Packaging requirements, and we offer the packaging with applicable instructions to be IATA 650 compliant. It is imperative that sites use the 650 packaging supplied (and according to packing instructions) to ship their specimens, as failure to do so may result in a package being denied for transport and/or the shipper being fined. Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 3 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 COUNTRY-SPECIFIC COURIER LIST The following table indicates the primary and backup courier services available for each country or region. You have received packaging supplies in your StarterPack for the courier service designated for your site. Please review the sections of the manual for your country or region. The Site Specific Summary provided in your StarterPack indicates when to use the primary and backup couriers, and provides you with sitespecific courier contact telephone numbers. Please contact your local courier office for package pickup cut-off times and shipment booking. Failure to adhere to these times will impact the transit time. Please record the booking reference, date/time of the call, and the name of the person contacted. COUNTRY ALL COUNTRIES Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites PRIMARY COURIER BACKUP COURIER (Mon-Fri) (Weekend & After Hours) ROOM TEMPERATURE FROZEN ROOM TEMPERATURE FROZEN LAB DHL DHL QUICKSTAT QUICKSTAT Quest Diagnostics Clinical Trials, Heston, Middlesex Page 4 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – PACKAGING FOR ROOM TEMPERATURE DIAGNOSTIC SPECIMENS Please ensure that the specimens are ready for pick-up at the time planned with the courier! PACKAGING THE SPECIMEN Slide each specimen vial into absorbent tube shuttle. Place folded requisition, printed side out, into back pouch of specimen transport bag. Roll up absorbent tube shuttle and slide into specimen transport bag. Follow closure instructions on bag when sealing. PACKING THE ROOM TEMPERATURE SHIPPER Maximum of two transport bags (12 x standard 10mL tubes) per shipping box Place specimen transport bag(s) on top of one air pillow*, and place second air pillow* on top of specimen transport bag(s). No more than two patient’s specimens can be shipped together. Close box flaps in numbered order. Remove adhesive strip from flap #3, and press down on flap #4 firmly to seal box. *Gel wraps should replace air pillows to surround specimens when outside temperatures are below 10C/14F or above 34C/93F. ADDRESSING AND DOCUMENTING THE ROOM TEMPERATURE SHIPPER BIOLOGICAL SUBSTANCE CATEGORY B - URGENT Add 5 Proforma invoices (for all non EU countries). Place the package in the DHL flyerbag. Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Stick the DHL Air Waybill for Room Temperature shipments on the bag. Page 5 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – TRANSPORT DOCUMENT: AIR WAYBILL FOR AMBIENT SPECIMENS Ensure you select the appropriate Air Waybill for your shipment(s)!: Air Waybill for Ambient and/or Cooled shipments. Fill out section 4 of the transport document with the number of boxes shipped and total weight (Ambient = 0,5 kg – Cooled = 3,5 kg). Fill out section 7 of the transport document with your signature and date. Keep the copy marked “Shipper’s copy” so as to have a record of the Air Waybill number should we need to trace the package. When shipping several packages, prepare as indicated, make a copy of the transport document and attach a copy of the document to each package. Ship individually, do not tape together. ! DHL Reference Complete section 4 Air Waybill Number Track this shipment via the DHL Web Site: http://www.dhl.com Shipment Air Waybill 1 ORIGIN Payer account number and insurance details Shipper Receiver 8 3rd party Products & Services Cash DHL Express Cheque Payer Account No. Credit Card Non-Duitable Document Priority MidDay Express Envelope (<200g) Standard European Community Express Dutiable Parcel Other Shipment Insurance see reverse Not all payment options are available in all countries. Yes Insured value (in local currency) 2 From (Shipper) Shipper's account number Domestic Contact name 4 Service options extra charges may apply Shipment details Total Weight Total number of packages kg Pieces ___@ gr Company name Address 5 Dimensions in cm Length Width Height x x ___@ ___@ x x x x ___@ x x Special Pickup Delivery notification Other Not all products or service options are available to/from all locations DIMENSIONAL/CHARGEABLE WEIGHT kg gr CHARGES Services UN3373 - BIOLOGICAL SUBSTANCE, CATEGORY B Phone, Fax or E-mail (required) Saturday Delivery Full description of contents Give content and quantity Postcode/Zip Code (required) Other Origin copy For more imformation see DHL Web Site or call your local DHL office 962990005 Shipper's reference (up to 32 characters but only first 12 will be shown on invoice) Deutsche Post Global Mail StartDay Other Insurance 3 Grey section for DHL use only Charge to DESTINATION CODE 405 1629 595 (Non negotiable) To (Receiver) VAT Company name 6 Delivery address DHL cannot deliver to a PO Box Dutiable shipments only (WPX) (Customs Requirement) CURRENCY TOTAL Attach the original and four copies of Proforma or Commercial invoice Shipper's VAT/GST number Receiver's VAT/GST or Shipper's EIN/SSN TRANSPORT COLLECT STICKER No. Declared Value for Customs (as on commercial/proforma invoice) Harmonised Commodity Code if applicable PAYMENT DETAILS (Cheque, Card No.) TYPE OF EXPORT Permanent Repair/Return Temporary Destination duties/taxes If left blank receiver pays duties/taxes Receiver Shipper Other No.: specify approved account number Type Postcode/Zip Code (required) Contact person 7 Country Phone, Fax or E-mail (required) Picked up by Signature Time Date Complete section 7 Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Expires Shipper’s agreement (Signature required) Unless otherwise agreed in writing, I/we agree that DHL's Terms and Conditions of Carriage are all the terms of the contract between me/ us and DHL and (1) such Terms and Conditions and, where applicable, the Warsaw Convention limits and /or excludes DHL's liability for loss, damage or delay and (2) this shipment does not contain cash or dangerous goods (see reverse). Page 6 Final 1.0 / / Route No. Date ‘UN3373 – BIOLOGICAL SUBSTANCE, CATEGORY B’ GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – PRO FORMA INVOICE FOR ROOM TEMPERATURE SPECIMENS (FOR ALL COUNTRIES THAT ARE NOT MEMBERS OF THE EUROPEAN UNION) EXAMPLE HOSPITAL DR. EXAMPLE EXAMPLE DEPT. EXAMPLE AVENUE EXAMPLE TOWN, UNITED KINGDOM EXAMPLE STUDY Consignee: QUEST DIAGNOSTICS – C.T.C. UPINDER GREWAL UNIT B1 PARKWAY WEST INDUSTRIAL ESTATE CRANFORD LANE HESTON, MIDDLESEX TW5 9QA UNITED KINGDOM Phone: +44(0)20-8377-3384 Fax: +44(0)20-8377-3382 PRO-FORMA INVOICE Unit Country Complete Detailed Unit Sub Units Type of Origin Description of Goods Value Total 1 SET UNITED KINGDOM BIOLOGICAL SUBSTANCE, CATEGORY B 5 5 Total Value: 5 Pounds Sterling (£) ALL CURRENCY IN POUNDS STERLING REASON FOR EXPORT: HUMAN BIOLOGICAL SUBSTANCE, CATEGORY B FOR RESEARCH AND ANALYTICAL PURPOSES ONLY SAMPLES HAVE NO COMMERCIAL VALUE ALL VALUES ARE FOR CUSTOMS PURPOSES ONLY I/we hereby certify that the information on this invoice is true and correct and that the contents of this shipment are as stated above. I/we do hereby authorize DHL International to execute any additional documents necessary for the export of merchandise described herein on my/our behalf. Signature Date Page 1 TO COMPLETE Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 7 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – PACKAGING FOR FROZEN DIAGNOSTIC SPECIMENS SPECIMENS FROM ONE PATIENT’S VISIT FROM ONE REQUISITION FORM PLEASE REFER TO THE DRAWING SCHEMES FOR TUBE(S) TO RETURN TO THE CENTRAL LABORATORY. Quest Diagnostics Clinical Trials Sponsor - Protocol - Visit Name Study ID: Protocol: Site: ssued: + INSERT TUBES IN ABSORBENT TUBE SHUTTLE AND WRAP ROUND Test Name Patient Visit LAB Copy - White (Room temperature) APPROPRIATE COPY OF THE REQUISITION FORM REQUISITION FORM IN FRONT POUCH PLEASE FOLD THE REQUISITION FORM WITH THE BARCODE FACING OUTWARDS A5 CLEAR SPECIMEN/REQUISITION BAG The quantity of tubes returned to Quest Diagnostics Clinical Trials in one frozen shipper box may vary, depending on the box and if it contains either pellet or plate dry-ice. But the maximum quantity of tubes and A5 clear specimen/requisition bags per 95kPa transport bag (received along with the dry-ice box) must be strictly respected: Small Frozen Shipper Box: the small 95kPa transport bag (15x22cm) which comes with the dry ice can hold a maximum of 12 tubes in either one or two clear A5 specimen bag(s). No more than 2 A5 specimen bags can be transported in 1 small frozen shipper box. Large Frozen Shipper Box: the large 95kPa transport bag (25x29cm) which comes with the dry ice can hold a maximum of 24 tubes in either one to four clear A5 specimen bag(s). No more than 4 A5 specimen bags can be transported in 1 large frozen shipper box. ONLY ONE (1) 95kPa transport bag per frozen shipper box Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 8 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – PACKAGING FOR FROZEN DIAGNOSTIC SPECIMENS 4 STEP 0 STEP 1 STEP 2 The shipment box is delivered with all necessary network documentation Remove the protecting outer carton. Keep it aside for usage at step 5 Inside is a DHL carton shipment box (with an internal polystyrene protection). All return shipment documents are already fixed on the box STEP 3 STEP 4 STEP 5 Carefully open the shipment box, then remove the 95kPa transport bag Place the A5 clear specimen/requisition bag(s) into the 95kPa transport bag and seal following the closure instructions printed on it STEP 6 STEP 7 STEP 8 Place the sealed 95kPa transport bag into the shipment box, on the remaining dry ice Fill the shipment box with all remaining dry ice, covering the sealed 95kPa transport bag Carefully replace the lid of the shipment box STEP 9 STEP 10 STEP 11 Close and tape the outer carton For non-EU country only, remove the pro-forma invoice from the document pouch, sign it and replace into the pouch Call your local DHL customer service before the Latest Call time (LCT) to arrange a pick up. Your DHL courier will arrive to collect your specimens Taking adequate precautions fill the cover carton with half of the dry ice WARNING : DO NOT tape over IATA labeling! Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 9 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – SERVICE GUIDE COLLECTIONS AND FROZEN DRY ICE Ordering Dry ice: If dry-ice is not sourced locally, DHL will provide dry ice & packaging upon request. Please fill out a “DHL Clinical Trials Frozen Shipper Request Form” and fax, phone or email DHL (refer to cut of times on SSI page and contacts provided on the form). Refer to the days and times indicated on the “DHL Clinical Trials Frozen Shipper Request Form”. You will receive a fax confirmation for any orders placed using the Frozen Shipper Request Form or an email confirmation for orders placed using the DHL email address. If a confirmation is not received please follow up with DHL to ensure that the order has been placed. It is the site’s responsibility to ensure they receive the confirmation and to follow up with DHL if required. A DHL courier will deliver dry ice to site on the requested date. However, this courier will not be able to collect the samples at time of delivery. A call to DHL’s customer service team is required for a collection of your repackaged shipment. The dry ice that you receive from DHL will usually be in ‘pellet’ form. However, if you receive dry ice on a Monday, or your site operates from a remote location then you may receive dry ice in ‘plate’ configuration. You will receive instructions appropriate to this type of dry ice with your consignment. The bag in contact with the dry-ice must absolutely be a 95kPa transport bag, IATA compliant. This will be supplied by DHL along with the dry-ice and packaging. Always replace the entirety of received dry-ice in the shipper box, never remove dry-ice if you consider there is not enough place for samples. If such situation should occur, order a new frozen shipper box. DHL Service: The cut-off times provided by DHL are designed to ensure connectivity of your shipment through their network. As such, they must be rigidly adhered to. Due to delivery commitments for other customers, the courier will be unable to deliver the dry ice and wait for the samples to be repackaged. Collection of the samples must be booked via the standard collection procedure. The DHL couriers are not allowed to repackage the samples on behalf of the Investigator. DHL will not come at a specific time within the cut off schedule provided. A collection window of up to two hours from ‘ready time’ to ‘close time’ may be requested. DHL will only deliver the dry ice container to the recognised central receipt point in a large medical facility. Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 10 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – PROCEDURE TO SEND FROZEN SPECIMENS - FROZEN REQUEST FORM (24) 1. Dry ice will be supplied by the Central Laboratory (using DHL) only upon request of the investigator. Fill in the document “DHL Clinical Trials Frozen Shipper Request Form” (see example below). 2. Please make a photocopy of the document and keep the original as a template. If blank, please write legibly in BLOCK CAPITALS in the delivery address/contact section. 3. Fax the completed form to + 353 61 36 5596. If you need assistance, call on + 353 61 36 5586 (Mon – Fri 08:00-18:00 CET). Email at quest.ekas@dhl.com 4. Orders are registered Monday to Friday (8h00-18h00). Do not hesitate to call if you have any questions about the order or delivery process. Deliveries are within business hours. 5. Please contact the DHL Customer Services number in your Specific Sites Information document (SSI) once the shipment is ready for collection. Note: an email or fax will be sent to confirm receipt of your order. You will be notified of any problems with your request by return fax or email. If the delivery address is pre-printed on the form & needs to be modified, please contact us by telephone or email. ! Please refer to the days and times indicated on the request form to order the dry ice. Specimens should be shipped on the same day the dry ice is received at site. Occasionally, dry ice will be delivered after the time for collection. If this occurs, samples must be stored locally in appropriate condition (refer to samples collection schemes) until shipment on the following day. Fill in delivery address Indicate delivery day. Use separate form if multiple despatch days Specify delivery date Tick corresponding box. Specify amount of tubes and bags if needed Date and sign the document Please note that dry ice delivery times are not guaranteed due to DHL deliveries made outside of sites’ opening hours! Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 11 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – TRANSPORT DOCUMENT: AIR WAYBILL FOR FROZEN SPECIMENS Ensure you select the appropriate Air Waybill for your shipment: Air Waybill for Frozen shipments (provided on the dry ice box). “Total number of packages”, “Total weight” boxes and “DRY ICE” note in section 4 will be pre-completed. Each box must have a separate Air Waybill. Fill out section 7 of the transport document with your signature and date. Keep the copy marked “Shipper’s copy” so as to have a record of the Air Waybill number should we need to trace the package. ! DHL Reference Pre-completed section 4 Air Waybill Number Track this shipment via the DHL Web Site: http://www.dhl.com Shipment Air Waybill 1 ORIGIN Payer account number and insurance details Shipper Receiver 8 3rd party Products & Services Cash DHL Express Cheque Payer Account No. Credit Card Non-Duitable Document Priority MidDay Express Envelope (<200g) Standard European Community Express Dutiable Parcel Other Shipment Insurance see reverse Not all payment options are available in all countries. Yes Insured value (in local currency) 2 From (Shipper) Shipper's account number Domestic Contact name 4 Service options extra charges may apply Shipment details Total Weight Total number of packages kg Pieces ___@ gr Company name DRY ICE Address 5 Dimensions in cm Length Width Height x x ___@ ___@ x x x x ___@ x x Special Pickup Delivery notification Other Not all products or service options are available to/from all locations DIMENSIONAL/CHARGEABLE WEIGHT kg UN3373 BIOLOGICAL SUBSTANCE, CATEGORY B, Dry ice class 9, UN1845 net weight 14kg Phone, Fax or E-mail (required) Saturday Delivery Full description of contents Give content and quantity Postcode/Zip Code (required) Other gr CHARGES Services Origin copy For more imformation see DHL Web Site or call your local DHL office 962990005 Shipper's reference (up to 32 characters but only first 12 will be shown on invoice) Deutsche Post Global Mail StartDay Other Insurance 3 Grey section for DHL use only Charge to DESTINATION CODE 405 1629 595 (Non negotiable) To (Receiver) VAT Company name 6 Delivery address DHL cannot deliver to a PO Box Dutiable shipments only (WPX) (Customs Requirement) CURRENCY TOTAL Attach the original and four copies of Proforma or Commercial invoice Shipper's VAT/GST number Receiver's VAT/GST or Shipper's EIN/SSN TRANSPORT COLLECT STICKER No. Declared Value for Customs (as on commercial/proforma invoice) Harmonised Commodity Code if applicable PAYMENT DETAILS (Cheque, Card No.) TYPE OF EXPORT Permanent Repair/Return Temporary Destination duties/taxes If left blank receiver pays duties/taxes Receiver Shipper Other No.: specify approved account number Type 7 Postcode/Zip Code (required) Country Contact person Phone, Fax or E-mail (required) Unless otherwise agreed in writing, I/we agree that DHL's Terms and Conditions of Carriage are all the terms of the contract between me/ us and DHL and (1) such Terms and Conditions and, where applicable, the Warsaw Convention limits and /or excludes DHL's liability for loss, damage or delay and (2) this shipment does not contain cash or dangerous goods (see reverse). Picked up by Signature Time Date Complete section 7 Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Expires Shipper’s agreement (Signature required) Page 12 Final 1.0 / / Route No. Date ‘UN3373 BIOLOGICAL SUBSTANCE, CATEGORY B, Dry ice class 9, UN1845 net weight GlaxoSmithKline – Protocol AC4113589 06 November, 2009 DHL – PRO FORMA INVOICE FOR FROZEN SPECIMENS (FOR ALL COUNTRIES THAT ARE NOT MEMBERS OF THE EUROPEAN UNION) EXAMPLE HOSPITAL DR. EXAMPLE EXAMPLE DEPT. EXAMPLE AVENUE EXAMPLE TOWN, UNITED KINGDOM EXAMPLE STUDY Consignee: QUEST DIAGNOSTICS – C.T.C. UPINDER GREWAL UNIT B1 PARKWAY WEST INDUSTRIAL ESTATE CRANFORD LANE HESTON, MIDDLESEX TW5 9QA UNITED KINGDOM Phone: +44(0)20-8377-3384 Fax: +44(0)20-8377-3382 PRO-FORMA INVOICE Unit Country Commodity Complete Detailed Unit Sub Units Type of Origin Code Description of Goods Value Total 1 SET UNITED KINGDOM 300239900 BIOLOGICAL SUBSTANCE, CATEGORY B 2.50 2.50 2.50 2.50 381121000 CARBON DIOXIDE, SOLID (DRY ICE) CLASS 9, UN1845 Total Value: 5 Pounds Sterling (£) ALL CURRENCY IN POUNDS STERLING REASON FOR EXPORT: HUMAN BIOLOGICAL SUBSTANCE, CATEGORY B FOR RESEARCH AND ANALYTICAL PURPOSES ONLY SAMPLES HAVE NO COMMERCIAL VALUE ALL VALUES ARE FOR CUSTOMS PURPOSES ONLY I/we hereby certify that the information on this invoice is true and correct and that the contents of this shipment are as stated above. I/we do hereby authorize DHL International to execute any additional documents necessary for the export of merchandise described herein on my/our behalf. Signature Date Page 1 TO COMPLETE Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 13 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 QUICKSTAT – PACKAGING FOR ROOM TEMPERATURE DIAGNOSTIC SPECIMENS Please ensure that the specimens are ready for pick-up at the time planned with the courier! PACKAGING THE SPECIMEN Slide each specimen vial into absorbent tube shuttle. Place folded requisition, printed side out, into back pouch of specimen transport bag. Roll up absorbent tube shuttle and slide into specimen transport bag. Follow closure instructions on bag when sealing. PACKING THE ROOM TEMPERATURE SHIPPER Maximum of two transport bags (12 x standard 10mL tubes) per shipping box Place specimen transport bag(s) on top of one air pillow*, and place second air pillow* on top of specimen transport bag(s). No more than two patient’s specimens can be shipped together. Close box flaps in numbered order. Remove adhesive strip from flap #3, and press down on flap #4 firmly to seal box. *Gel wraps should replace air pillows to surround specimens when outside temperatures are below 10C/14F or above 34C/93F. ADDRESSING AND DOCUMENTING THE ROOM TEMPERATURE SHIPPER All the transport documents will be provided by QuickSTAT courier only upon request. Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 14 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 QUICKSTAT – PACKAGING FOR FROZEN SPECIMENS SPECIMENS FROM ONE PATIENT’S VISIT FROM ONE REQUISITION FORM PLEASE REFER TO THE DRAWING SCHEMES FOR TUBE(S) TO BE RETURNED TO THE CENTRAL LABORATORY. Quest Diagnostics Clinical Trials Sponsor - Protocol - Visit Name Study ID: Protocol: Site: ssued: Patient Visit + Test Name LAB Copy - White (Room temperature) INSERT TUBES IN ABSORBENT TUBE SHUTTLE AND WRAP ROUND APPROPRIATE COPY OF THE REQUISITION FORM REQUISITION FORM IN FRONT POUCH PLEASE FOLD THE REQUISITION FORM WITH THE BARCODE FACING OUTWARDS A5 CLEAR SPECIMEN/REQUISITION BAG More than one patient's specimens can be shipped together ALL TRANSPORT MATERIAL AND ALL DOCUMENTS WILL BE PROVIDED BY QUICKSTAT ONLY UPON REQUEST ENSURE YOU HAVE ORDERED BOXES, DOCUMENTS,… WHEN CALLING PICK-UP TO ORDER DRY ICE AND SUBMIT YOUR SPECIMENS TO THE CENTRAL LABORATORY PLEASE REFER TO PROCEDURE ON NEXT PAGE Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 15 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009 QUICKSTAT – PROCEDURE TO SEND FROZEN SPECIMEN 1. Dry ice will be supplied by QUICKSTAT only upon request of the investigator. In order to obtain dry ice, please contact your local QUICKSTAT office using the telephone number on the separate Site Specific Information sheet provided with this manual. ! QUICKSTAT needs a 24 hours notice in order to get the dry ice box to your centre. 2. QUICKSTAT will provide the box containing the dry ice as well as all transport documents on the requested day. 3. Place the specimens in the polystyrene box containing the dry ice. 4. Close the box carefully and seal with the adhesive tape provided. 5. QUICKSTAT will immediately take the dry ice box away for delivery to the Central Laboratory. Quest Diagnostics Clinical Trials, 7HS Contact and Shipping Information European Serviced Sites Page 16 Final 1.0 GlaxoSmithKline – Protocol AC4113589 06 November, 2009
