PH Quality Management System Reference F-LAB-048

Document title Version 8

Request for Laboratory Date 30.06.2013

Author J. T. Samonte
Analysis (External Samples) Approved by M. L. Peneyra
SGS Job Number: ____________________________

REMINDER: Please write legibly, some details affirmed here will be reflected in the Final Report.

Company Name/ Personal Name ____ ____

Address: _______________________________________________________________________________________________________
Tel.No.: _________________________ Mobile No.: __________________________ Fax. No.: _______________________
E-Mail Address:  _______________________________________________________________________________________________
Contact Person: _____________________________________ Position : ___________________________________________

Receipt of Samples:  Submitted  Picked Up  Sampled  Courier

Printed Name: _______________________________________

Date & Time: _________________________________________
Signature: ____________________________________________

SGS Sample No. Sample Name Analysis Requested

We apply for the above test/s and agree that this contract will be Conforme:
carried out subject to SGS Philippines, Inc. General conditions of
service available upon request, and accessible at __________________________________________
www.sgs.com/terms _and_conditions.htm (Client Signature Over Printed Name)

UNCONTROLLED COPY
The latest revision of this document and the official distribution list are those approved in the QMS software
 PH Quality Management System Reference F-LAB-048
Document title Version 8

Request for Laboratory Date 30.06.2013

Author J. T. Samonte
Analysis (External Samples) Approved by M. L. Peneyra
To be filled-out by SGS Personnel

P.O. Number / Ref. Quotation Number :

Purpose of Test / Product Use :
Preferred Method of Analysis :
 Standard Methods  Client Supplied  SGS In-House Method  Others :

Types of Service:  Regular Service  Rush Service

Report Format:  SLIM  Special Format
Particulars of Special Format / Instructions: _______________________

Dispatch Through:

 Delivery  Courier  Picked-up  E-Mail  Fax

Payment Details:
Amount O.R. No. Date
TOTAL COST
DEPOSIT
BALANCE

Sample/s Received By: _____________________________________________________

Date & Time Received: _____________________________________________________
Checked / Reviewed By : __________________________________________________

Remarks/ Special Instructions:

Dispatched Details:

Dispatched By: _______________________ ____ Date & Time: _______________________

Received By: _______________________ ____________ Date & Time: _______________________

UNCONTROLLED COPY
The latest revision of this document and the official distribution list are those approved in the QMS software