Analysis Requisition Form Name & Designation of User :
Contact No. & e-mail ID of User :
Department / Institute :
Working Parameter(s) :
Sample description :
Number of Samples :
Amount Details by cash : Date:
by DD : Date:
(DD will be made in the favor of the Registrar, University of Kota, Kota payable at Kota)
Signature of the User
Declaration:
1. If the proposal is accepted, I will send two copies of report on the work carried out at Department of Pure and Applied Chemistry, University of Kota, Kota. Within one month of work.
2. A copy of the resulting publications, if any, will be send to Department of Pure and Applied Chemistry, University of Kota, Kota.
3. Every such publication shall carry the following acknowledgement: “This work (part of this work) was performed at Department of Pure and Applied Chemistry, University of Kota, Kota”, under the analytical assistance of the faculty In-charge Dr./Mr./Mrs.…………... and designation………..
Name & Signature of Supervisor/In-charge
Forwarded by: Permission granted by:
Head
Facility in-charge Department of Pure & Applied Chemistry
Receipt
Book No: Serial No: Date:
Name of research scholar/supervisor :
Name of the Department/Institute :
Details of analysis :
S. No. Nature of job/analysis Charges/sample No. of samples
Total amount
(in Rs.)
Details of amount received by cash/DD:
Received by
(Name & Signature) (Print in three copies as candidate copy, requisition form copy and office copy)
For any further queries contact: 0744-2411742
