ANALYTICAL LABORATORY

MALAYSIA-JAPAN INTERNATIONAL INSTITUTE OF TECHNOLOGY (MJIIT)

UNIVERSITI TEKNOLOGI MALAYSIA

PARTICLE
SIZER/ ZETA

Tel : 03 2203 1532

Email : naim.kl@utm.my
norshakira.kl@utm.my

Name of Applicant
Status of Applicant
Student Matric No.
Faculty/ Department/ Company
Hand Phone No. & Email

Undergraduate
s

Master

Research

PhD

2. SUPERVISOR DETAILS (for UTM/ others University applicant only)

Name of Supervisor
UTM Staff ID No.
Research Alliance
Faculty/Department
Hand Phone No.
Email
Research Vot Title (UTM)
Research Vot No. (UTM)
Balance of V29000 (UTM)
Signature & Official Stamp
3. SAMPLE INFORMATION FOR ASE/ASPE EQUIPMENT
Number of Sample
Sample Labels & Information
(Please specify the chemical formula for
each sample)

Type of Sample

Solid

Powder

Gel

Liquid

Weight of sample
Diluent/Solvent

Water

Refractive Index (for Particle Sizer)

Others

______

______ (dispersing agent)

______ /specific material/special material

Other Condition

Please Specify any Result Expectation

*Analysis only could be done on 2nd and 4th week every month
Method of payment: Cash

Cheque

Vot Transfer

(Tick which applicable)

*Cash: Payment made OTC at MJIIT Admin Office, level 2 (Mrs. Mazliza Aini)
**Cheque: Cross cheque with written to Malaysia-Japan International Institute of Technology

FOR OFFICE USE ONLY

Application Status :
Signature

Approved

Not Approve
Official Stamp :

Date Completed :