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Form No.

MTH / F/01: Rev: 00


MATERIAL TESTING HOUSE (INDIA) LTD
50-96-4, North Extension, Seethammadhara, Visakhapatnam-530013
Tel: 0891- 2791342, Email: mthindialab@gmail.com
CUSTOMER REQUISITION
From, Date:__________

Sir, We request for the following tests for the samples submitted
Sample No. S- Sample details Tests Ref. Code No./ Qty

Name, Contact No. & Sig. of Customer


or their representative
For Is the facility / Is the Sample Are the test methods
Review skills available suitable for understood & explained to Request Accepted
M of for testing Testing the Customer
Request
Yes Yes Yes Yes
T

H
Requisition No. RQ Date of Completion of Test Report Sig. of In-charge
use As per Customer
Planned Completed
request
only

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