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SAMPLE SUBMISSION FORM

Ref. No. :
PROJECT
TITLE : Submitted
By :
SUBMIT TO : Date :
ATTENTION : Project No.:

Sample Description: Compliance Verified by

Verified by Specification Status by Client
Consultant Remark by Client
Contractor (√ according to Project Project Manager /
Sample No: or N/A) contract Manager
Consultant
No Items (A, B or C)
1 Catalogue

2 Supplier’s Company Profile

Supplier’s Project Reference
3
List
4 Technical Specification
Sample Warranties /
5
Certificated
6 Sample Material

7 Others
Status Indication:
A – Reviewed and accepted
B – With-hold acceptance subject to compliance as commented. Please review and submit
C – Rejected. Please revise and resubmit
Acknowledge Receipt by: Approved by: Status Verified by:
(sign & chop) Client Project Manager (Sign & Chop) Consultant (Sign & Chop)

Name: Name: Name:

Date : Date Date :

(if applicable) :
Accepted / Not Accepted by S.O / S.O Comments:
Representative

Name & Chop:

I/C No:

Copies To :
Client – (attn: ) ID – (attn: )
Client’s Project Manager – (attn: ) M&E – (attn: )
Architect – (attn: ) Others – (Company Name)

This facsimile was transmitted on: Date Time: