SAMPLE RECEIPT FORM
Receiving Date
*
/
Day
/
Month
Year
Date
Time
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
:
Hour
00
10
20
30
40
50
Minutes
Company Name
*
Address
City
State / Province
Postal / Zip Code
Contact Person
*
Email
cslab.id@tuv-nord.com
Phone Number
*
-
SAMPLE TESTING FORM
Sample Name
*
Quantity
Type a question
Dry (20-25°C)
Chill (0-8°C)
Frozen(< 0°C)
Parameters Testing (Micro)
Parameters Testing (Chemical)
Priority Status
Normal (10 HK)
Urgent (7 HK)
Very Urgent (5 HK)
Note
Signature of Customers
*
Signature of Receiver Sample
*
Should be Empty: