FORM-1 PT DIVISION LANDMARK MATERIAL TESTING AND RESEARCH LABORATORY CONSENT TO PARTICIPATE IN PT SCHEME -Fill the details as per following (Handwritten or typed) ‘Submit separate form for each round of PT participation Submission of scanned image ofthis form through Email is acceptable. prow [ET R[E[P[T[STUTB[E] [3] 2 Product: Concrete Name ofthe Laboratory: Raipur Metallurgical Lab Name ofthe contact person (Mr) Joby George. Designation: Quality Manager ‘Adatress for Reporting: Village Jarwah Bana Guma Road .Nesr Yaduvanshi Chowk Hirapur, District..Raipur State: Chhattisgarh PIN: 492099 ‘Telephone: 9516461113 Mobile : 9826187333. E-mail: METLAB_RYP@YAHOO.COM (InBlock Letters only eg, XAMPLE@XY2MAIL.COM) Preferred Courier Agency : First Flight, Blue Dart Please use below address for sending samples and report only. Raipur Metallurgical Lab. Address: 217, 2" Floor, Rishab Chambers, MG Road, Raipur(C.G) 492001, (Ptease mention the names of more than one courier agencies those have good service network at your doorstep) fe the following check boxes in acceptance of the statement written ahead: i / Ws express our consent to participate in the PT round, ID of which is mentioned above ae have read and understood the protocol and convinced with the test parameters and respective test thods. ee, re ptr ln cainieate Wid eter oer utremc ea apeciid a fs testrnesion a ‘be made available during the test. 1/We understand that my /our participation may be revoked on non compliance with test method and/or time schedule as instructed by PTP. contd, 2 LRL/PT/F-1 /, Rev. 03, Date of issue: 25.10.201811 Our Laboratory is accredited as per 150:17025 in above all / some test parameters and our registration nymber Is which is valid upto ur Laboratory is not accredited as per 160:17025 in all / some test parameters, whereas only calibrated equipments will be used in particular tests and calibration status will be submitted along with PT results for non accredited parameters. Participation fee along with GST is enclosed herewith as per following detail: [ Fees Discount Net Amount GST @18% Total Amount | peisom 800 7200 as 1236 ‘Avail any one discount from Following: 1. Avail opportunity discount @ 5% if applying first time for LRLPT. OR 2, To avail privilege discount @10%, please mention any previous PT round ID of LRL/PT_/../17 or LRL/PT_/.../18, in which you have participated oR 3. To avail group discount @15%, please participate in minimum three or more PT rounds of above PT calendar of 2019 and mention the other two PT round IDs in which you are applying along with this Gos i oe and (i. Payment Detail: Cheque’/DD*/NEFT No: .- Dated, Drawee bank. Your GST No. : EPFPPEEPEP PPE Er Nase Sige Si Geengs Toseph | SS | | Authorized Wignatory) Bank Account Details for payment: Account Name: Landmark Material Testing And Research Laboratory Pvt.Ltd. Bank: HDFC BANK Ltd., Bank Address: ICG Campus, Gurukul Marg, SFS, Mansarovar, Jaipur- 302020, Account No. 0200027909480, |FSC: HDFCO000987, Swift code : HDFCINBBXXX PAN AABCL9797K, GSTIN - OBAABCL9797K1ZN, SAC-998349, *cheques/D0 shal be drawn in favour of “Landmark Material Testing And Research Laboratory Pvt. Ltd” payable at Jaipur EMAIL SCANNED IMAGE OF DULY FILLED FORM TO: LRLPTJPR@gmail.com > LRY/PT/F-1 /, Rev. 03, Date of issue: 25.10.2018