Form

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Expert mineral services with cutting-edge technology and decades of experience.

Customers Registration & Sample Hand Over Format

Ethiopian Mineral Corporation - Laboratory Service Center

Form 004

Company Name:

Sample Type:

Number of Samples:

File Name:

TIN Number:

License Number:

Contact Person:

Mobile Number:

Date Submitted:

Sample Delivery Date:

Analytical Methods	Remark
Code

Field Numbers (enter one per line):

Lab Numbers (enter one per line):

Samples will be disposed of after 90 days unless otherwise agreed.
The customer is responsible for ensuring samples are properly labeled and comply with safety regulations.
Results will be provided as per the agreed delivery date unless unforeseen circumstances arise.
Payment must be made as per the agreed terms.

I agree to the terms above.

Hand Over by (Name):

Received by (Name):