Receipt Of Samples

BUREAU OF INDIAN STANDARDS Serial No.

Date RECEIPT FOR SAMPLE(S)

[ Issued under Regulation 5( 11 ) ( f ) of the Bureau of Indian Standards ( Certification ) Regulations , 1988 ]

Received the undernoted sample/samples from __________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ for the purpose of examination in accordance with the provisions of the Bureau of Indian Standards Act, 1986 and rules and regulations made thereunder. The sample/samples was/were taken and sealed in presence of _____________________ _______________________________________________________________________ _______________________________________________________________________ Brief description of sample/samples And impressions of seals, if sealed :

__________________________________ __________________________________ Signature and designation of the person in whose presence the sample/samples was/were taken.

_______________________________ Inspecting Officer Bureau of Indian Standards