Nama Instrumen: Microskop Imbasan Probe /
Scanning Probe microscopeMaklumat Pemohon:
Applicant's Information:
1. Nama: 2. Telefon:
Name: Telephone:
3. Jabatan/Fakulti/Agensi: 4. Mel‐E:
Department/Faculty/Agency: Email:
5. Status: 6. Alamat:
Status: Siswazah/Master Address:
Prasiswazah/Undergraduate Penyelidik/Researcher Kakitangan UKM/UKM Staff Pasca Doktoral/ PhD
Luar UKM/Outside UKM 7. Tandatangan:
Lain‐lain/Others Signature:
Maklumat Sampel:
Samples Information:
1 Kadar Bayaran Perkhidmatan/ Rate Of Service
Kaedah Analisis/ Analysis Method Tempatan / Local Luar UKM / Outsider
Morphology (AFM) RM 40.00 RM 140.00
Morphologi (AFM) + Concuctivity RM 60.00 RM 170.00
Scanning Tunneling Mode (STM) RM 60.00 RM 170.00
AFM / STM Spectroscopy RM 50.00 RM 150.00
Magnetic Force Microscopy (MFM) RM 60.00 RM 170.00
Electric Force Microscopy (EFM) RM 60.00 RM 170.00
Kelvin Probe Microscopy (KPM) RM 60.00 RM 170.00
AFM/ STM Electrochemistry RM 120.00 RM 240.00
Heating Stage RM 20.00 RM 240.00
2 Bilangan Sampel/ No. Of Sample :
Perakuan Dekan/Pengarah/Ketua Jabatan/Ketua Projek Penyelidikan:
Dean/Director/Head of Department/Research Project Leader Verification:
Saya dengan ini bersetuju untuk membayar semua kos seperti yang ditetapkan:
I hereby agree to pay all the cost stated:
Kos analisis:
Analysis cost:
Kod peruntukan (jika berkenaan):
Code of research project (if any):
Tandatangan/Signature:
(Cop rasmi/Official stamp) Nama:
Name:
Tarikh:
Date:
Perakuan Pengguna/ Declaration of User
Saya bersetuju untuk memberi *penghargaan kepada CRIM di dalam penerbitan yang dihasilkan menggunakan instrumen ini./
I hereby agree to acknowledge CRIM in my research publication for the support given.
Tandatangan/Signature:
*Contoh Penghargaan/ Example of Acknowledgement
‘The authors acknowledge Center For Research and Instrumentation Management (CRIM) for the support given.
Untuk kegunaan pejabat:
For office use only:
1. Tarikh hantar: 2. Tarikh siap: 3. Tarikh ambil: 4. ID tempahan:
5. ID sampel: 6. Tandatangan Pegawai:
Cop Rasmi:
Tarikh:
BORANG TEMPAHAN INSTRUMEN / INSTRUMENT BOOKING FORM PUSAT PENGURUSAN PENYELIDIKAN DAN INSTRUMENTASI (CRIM)
Makmal Morfologi CRIM (Makmal SPM) Unit Mikroskopi Elektron,
Fakulti Sains dan teknologi, Universiti Kebangsaan Malaysia
Tel: 03‐8921 3336 Emel: [email protected]
