Institute of Chemical Technology

Department of Chemistry

X-Ray Diffraction Analysis (XRD) (Request for sample analysis)

Presence of the user during analysis is MANDETORY

Date
Name of Student
Name of Research Supervisor
Dept. of Student and Research Supervisor
Thesis Title

Form of Sample Solid powder

Number of samples
Permission sought for XRD

Note: (1) Sample will be analyzed on a first- come-first-served basis.

(2) Only Powder samples / film will be analyzed.
(3) Sample quantity required 1 to 5gm.

Declaration from Research Supervisor

This data is required as a of part research work for the degree of_________________________.
I am ready to bare the operational cost of analysis. This amount will be utilized for maintenance
and upkeep of the instrument/analytical facilities.

I therefore permit, transfer of amount Rs. __________/- (…..samples × 500 per sample)
from my research grant ____________________________________________ to the account:
“Department of Chemistry, Instruments Maintenance Fund” Ac. No.-1101.

Signature of Research Supervisor

Details of the sample and its preparation: with date
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Purpose of XRD:
______________________________________________________________________________
______________________________________________________________________________

Signature of Signature of Signature and stamp of Permission Granted

Student Research Supervisor concerned H.O.D. (Prof. B.M. Bhanage)