CENTRAL POWER RESEARCH INSTITUTE

Name of the Unit / Division:

Format No: CPRI/QAF/01A Issue No. 02

Date of Issue: 22-06-2022
Revision No.00
Date of Revision: - Sheet 1 of 3
Customer Request Form

Name and Address of the Customer : Spectrum Smart Switchgears Pvt Ltd
Back side area ¼ second floor east patel nagar new
delhi 110008

Sample(s) to be tested : MCCB

Rating of the sample(s) to be tested : 400A

Description of the test sample(s) : MCCB

Type : Circuit Breaker

Serial Number(s) : SPCT8- MM400

Manufacturer’s Details : Spectrum Smart Switchgears Pvt Ltd

Back side area ¼ second Floor east Patel nagar New
Delhi 110008

Drawing Number(s) :

Customers Requirement : Sequence II, III

Criteria for Evaluation : IEC 60947-2

(Standard/Specification)

Number of Samples : TWO

Sample storage /Handling/Disposal
: a) Taking back the sample after testing :Yes
b) Will not take back the sample,
CPRI can scrap and dispose it off : No
Note: If samples are not collected as in (a) within
15 days from the date of testing it will be
automatically scrapped.

Details of test(s) requested : Sequence II, III

Specific instructions (if any) for

mounting and connection :
Name of the witnessing persons
Customers Representative :
Other than Customer :

Test Report to be despatched to : Spectrum Smart Switchgears Pvt Ltd

Test report Despatch mode : Courier

Number of Additional Test Reports : Not required

(Required / not required)
 CENTRAL POWER RESEARCH INSTITUTE

Name of the Unit / Division:

Format No: CPRI/QAF/01A Issue No. 02

Date of Issue: 22-06-2022
Revision No.00
Date of Revision: - Sheet 2 of 3

MSME Discount : Applicable

Whether statement of conformity

is required in the test report : Yes No
(Please tick the appropriate one)

a) if No, then only the observed results will be reported in the test report as summary of
testing/conclusion

b) If Yes, Please select any one of (i) OR (ii) OR (iii)

i) Decision on compliance to standard/specification will be based on the

requirement mentioned in the standard/specification and independent of the
Measurement Uncertainty

ii) For the requirement specified by the customer, same will be considered as decision
criteria and independent of the Measurement Uncertainty

(Deviations requested by the customer in the customer requirement shall be above the
requirements of the standard/specification and wherever the requirements need to be specified
by the customers or not specified in the standard/specification. Deviations requested by the
customer shall not impact the integrity of the laboratory or the validity of the results)

iii) If Measurement Uncertainty is to be considered for the decision on compliance,

calculated Measurement Uncertainty at confidence level of approximately 95% (k=2)
will be reported in the test report. Compliance determination based upon the
observed result and associated measurement uncertainty shall be decided
by the customer / End user.

(Decision criteria cannot be changed after the start of the test)

Note: 1) CPRI Website will publish information on manufacturers’ name, products tested, test report
number & date of issue and corresponding unique sample code number.
2) The terms & Condition document is made available while making the offer from CPRI for testing.
The document is also available in CPRI web site www.cpri.in . Customers are requested to go
through the document carefully before proceeding for testing.

I/We guarantee that the sample submitted for the test(s) has been manufactured in accordance with the
drawings submitted.

I/We have read & understood the terms and condition for testing at CPRI and agree to the conditions
stipulated there in.

Customers Name & Signature with Date

 CENTRAL POWER RESEARCH INSTITUTE

Name of the Division:

Format No: CPRI/QAF/01A Issue No. 02

Date of Issue: 22-06-2022
Revision No.: 00
Date of Revision: -
Sheet 3 of 3
(To be filled by the laboratory)

Whether laboratory has capability to :

take up to the work

Test subcontracted :

Name & signature of Test Engineer/Test :

In charge for accepting the job, with date

(The following information is to be filled after testing, if applicable)

Discrepancies if any noticed during testing :

Communication to Customer for his approval : By Telephone /in person

of the Discrepancies
(Record of the discussion)

Name & Signature of Test Engineer/Test In Name & Signature of Customer with date
Charge (with date) (if present)