Joint Sampling Statement

Dated On at

We as below assigned named carried out a joint sampling with detail :

- Cargo :
- Cargo ex. :
- Quantity total :
- Location of Cargo :
- Lab for Analysis :
- Parameter Analysis :

- Number of sample :
- Seal no of sample :

(Full name & Company name ) (Full name & Company name )

(Full name & Company name ) (Full name & Company name )

@MS09/16