SERVICE REQUEST Laboratory’s Use Only

SLEEN INDIA BIZ VENTURE PVT LTD

(An Institutional AFMEC Lab) /REVIEW FORM Format No. QR/04
Revision No.: 03
Report. No.: Date:-10/03/2021

Applicant Information Invoicing Information

Customer: SHIVANSH MAHAJAN Company Name : M D OVERSEAS
Address : 176-B, BALUGANJ, AGRA 282001

Address : 176-B, BALUGANJ, AGRA 282001

GST No.: 09AAZFM4982A1ZQ
MSME/ Udyam No.:
Contact Person : SHIVANSH MAHAJAN Contact Person(Accounts): AMIT

Phone : 8958747777 Phone(Accounts): 7300559976

E-mail : SHIVANSH@MAHADEVGROUP.IN Email(Accounts):OFFICE@MAHADEVGROUP.IN

Mode of Sample Collection :
By Courier: By Hand: YES SLEEN Rep.-

Courier Address: i-16 Karmyogi Enclave, Kamla Nagar, AFMEC MEMBER Yes/No
GST: 09AAGCS1613L1Z8 Agra-282005 (UP)
IEC: AAGCS1613L MSME:UDYAM-UP-01-0002901 PAYMENT ADVANCE CREDIT
Service Type Regular Express (50% surcharge) Most Urgent (100% surcharge)
(3-4 Working Day) (2 Working Days) (1 Working Day)
SAMPLE DESCRIPTION
Article/ Style Name : LANGUAGE SOLE P.O./ Style No.:
Materials : TPR Color :
Category: FORMAL Ref. Job File No.:
Country of Origin: INDIA Destination Country :
Buyer : Brand:
TESTS REQUIRED
Receipt No./Job
Sl.No. Type of Sample Quantity Analysis/Test Required Test Method
ID
1 SOLE 1 ODD SOLE ABRASION & SOLE FLEXING 50000 CYCLE
2

Date of reporting: Reporting Methodology:-By Courier /Personal / E-mail

Customer test need identify & agreed. Date of login:
Terms & Condition:
1. Rate & Service charge are payable trough NEFT in favor of SLEEN INDIA BIZ VENTURE PVT LTD , Payable at Punjab National Bank, Kamla Nagar, Agra (UP),
A/C NO: 1842002100053851, IFSC: PUNB0184200
2. Sample accepted for testing may be returned untested, due to circumstance beyond our control.
3. All possible care will be taken in handling of sample but the risk of damage during testing or due to natural calamity shell be borne by the customer.
4. The test report is not to be used for any legal purpose and shall not be produced in court of law unless otherwise agreed upon.
5. After the completion of the tests and issue of report, the sample will be disposed of as per company policy unless stated.
6. The customer shall be responding for any information provided by him in the Service Request Form.
7. In case of any dispute, the decision, of the technical manager, SLEEN INDIA BIZ VENTURE PVT LTD shall be final and abiding to the customer.
8. The terms and condition are subject to change / modification without any prior notice.
9. In the event of cancellation of the testing of sample, charge will not be refunded.
10. The test results relate only to the sample (s) under test and applicable parameter (s) only.
11. The claim is subjected to maximum of invoice value of job conducted & subjected to Agra jurisdiction only.
12. As per Sleen code of ethics policy all information will kept confidential & will not be shared to any or else unless stated.
Confidential Complaint directly to Director NESHESH AGARWAL at Mob: +91-9997870009, 9319487009
*I hereby declare that the sample (s) detailed below/ are submitted with the knowledge and the authority of my company, and on behalf of my company. All
commercial terms as well as delivery of report time agreed.
Signature of Customer : Date: Time:
* In case of personnel delivery of my sample(Customer cell In-charge)
Comments after Review: ( Office Use Only)
Test methods are adequately defined, documented and understood. Yes / No
The laboratory has the capability and resources to meet the requirements. Yes / No
Appropriate test methods as per NABL accreditation is selected and capable of meeting the customer requirements. Yes / No
Application of decision rule required. Yes / No
External provider services used. Yes / No