ACE/8.

2/R-06

No: ACE/2016-17/ Date:

Service Request Form

1. Name of the Client :

2. Name of Project :

3. Date of Casting :

4. No. of Cubes :

5. CASTING DAYS:

6. Grade of Concrete:

7. Mark on Cube:

Terms & Conditions:

All possible care will be taken in handling the samples. We will not be responsible for any damage
during transit or handling.

I/We agree to the above Information & terms and conditions.

Signature of Client or its Representative