COMPLIANCE AUDIT

Version 1 (08-Aug-2014)
Test request form TEST REQUEST
SERVICE REQUIRED:
FORM Application No :PAL/IX/01

REGULAR (5 working days) EXPRESS (3 working days, +40% surcharge) DOUBLE EXPRESS (2 working days +100% surcharge)
QAS only bear the Regular service testing cost, upgrade service surcharge should be paid by submitters
SGS HONG KONG SGS SHANGHAI SGS GUANGZHOU SGS Pakistan – SGS INIDA SGS VIETNAM
Karachi
Address: 4/F, 5/F & Units Address: 4/F, 4th Building Address: 198 Ke Zhu Road, Address: H-3/3, Sector 5, Opposite to State Bank of Address: LOT III/21, 19/5A
301-4, 307-11, 3/F, No. 889, Yishan Science Park, Korangi Industrial Area, India, 28/B/1 (SP), Street, Industrial
On Wui Centre, Road, Xuhui Economics & Karachi, Pakistan B/2 (SP), Second Group III, Tan Binh
25 Lok Yip Road, Fanling, District, Shanghai, Technology phone: +92 21 111 222 747 Main Road; Industrial Zone, Tay
N.T., Hong Kong China Development Zone, +92 21 3512 1386 Ambattur Industrial Thanh Ward, Tan
Tel: 852-27747151 上海市徐汇区宜山路 889 Guangzhou, CHINA Estate, Phu District, HCMC,
号 3 号楼 5 楼 510663 Chennai - 600058, Tamil Vietnam
Tel: +86 (021) 61152282 广州市经济技术开发区科学城科 Nadu, India Tel: +848 38 160 999
珠路 198 号 Tel: +91 44 66081600
Tel: +86 (020) 3213 6605

APPLICANT
Applicant’s Name: QUIKSILVER ASIA SOURCING Contact Name: Florence Cheung / Leslie Poon
Unit A, 2/F, Kader Building, No. 22 Kai Cheung Road, E-mail:Please follow QAS report distribution list + Submitters email
Address: Kowloon Bay, Kowloon, Hong Kong
Phone:2158 0505 / 2158 0540
STYLE REQUESTED FOR AUDIT
Vendor Name: 1001067-PLUS APPAREL LIMITED
Season: 20S1 (Spring 20)
Style Number: S2BS14
Style Name: 73 STRIPPE PRO BOY
Sample Size: 1 pc per colour+10 heat transfer label at back side +cord tip
QUIKSILVER ROXY DC SHOES Billabong RVCA
Brand Name:
Elements Von Zipper Xcel Kustoms Honolua
SUBMITTER INFORMATION
*Submitter Name: PT PLUS APPARELLIMITED
Komplek Puri Sriwedari Blok F-6A, RT 004 RW 012 Kel. Harjamukti Kec. Cimanggis,
*Address:
Depok, Jawa Barat, Indonesia 16454
*Contact Person: WIWIK *Phone: : +62-21-8459 4290
*E-mail: wiwik@m-corp.co.id
SAMPLE INFORMATION
Additional Description: S2BS14 73 STRIPE PRO BOY
Color: NEON ORANGE
Fiber Content: 90%POLYESTER 10%ELASTANE
Fabric Weight: 158GSM
Fabric Number: USBBF707135
Trim Number: GLBBT701820 -RECYCLER 73 PRO HEAT TRANSFER / GLBBT701382-POLY FLAT FLASH DRAWCORD 7MM
*Age Grading: Adult Children (Please specify age range:     ) Baby (3 years old & under)
*Containing PVC: NO Yes, please specific:      
*End Product: PO#99298
RETESTING (Vendor should be responsible for all charges related to failure report, including retesting charges)
Previous Report
     
Number:
Billing to Submitter: Billing Company Name:      
Address:      
YES NO Contact Person:       Phone:      
(Please specify)
E-mail:      
I CERTIFY THAT THE SAMPLES PROVIDED HEREWITH ARE SUBSTANTIALLY THE SAME AS THE PRODUCTION PRODUCTS.
Date 日期 :      Submitter Signification:
Please Signify Your Acceptance By Authorized Signature & Company Chop:

(See General Conditions of Service Printed Overleaf)

*- Must be filled
LAB INTERNAL USE ONLY
Lab Received Date Expected Due Date Submission Number Remark

Test Item Section

* Subject to the applicability on the requested testing and the service availability to be determined by SGS.
Our services are subject to the terms and conditions described in SGS website: (http://www.sgsgroup.com.hk/en/Terms-and-Conditions.aspx)
ABQUIK03_V5_20190522e

SGS Hong Kong Ltd. Laboratory: 1/F, 4/F, 5/F & Units 301-4, 307-11, 3/F, On Wui Centre, 25 Lok Yip Road, Fanling, N.T., Hong Kong
Pick-up: t (852)27747133 / f (852) 23345251
General Enquiry: t (852) 27747151 / f (852) 27643276
Member of the SGS Group (SGS SA)

The application form is available at www.hk.sgs.com/forms