INDIAN INSTITUTE OF SCIENCE EDUCATION AND RESEARCH BHOPAL (IISER)

Central Instrumentation Facility (CIF)

Requisition Form For SEM
(Project No. - SEM/CIF/2015010)

Terms and Conditions:

1. Samples should be sent along with the duly filled & signed Requisition Form in envelopes with the
facility name and experiment super scribed on the envelope.
2. Payment should be made online in advance and ONLY through SBI collect, and Receipt having
transaction ID should be enclosed with the samples sent.
3. The expected time of results can range from two weeks to a month (downtime of instruments due to any
technical reason shall be excluded while calculating the aforementioned duration. In case of such delays
there will be no financial implications on IISERB).
4. Samples without payment receipt (generated through SBI collect) will not be run/analysed.
5. IISER Bhopal will not send samples back after sample run/analysis through post. No acknowledgement
of receipt of sample will be sent.
6. IISERB will send an invoice by post once a month (second week of every month).
7. IISERB reserves the right to accept /reject the samples received, or to analyze any particular samples on
priority basis. For samples that are not run/analysed, money will be refunded.
8. For payments made without following the above mentioned procedure, samples will not be run. Any
refund shall be made upon written request submitted on letter head duly signed by competent authority
of Institute/organization alongwith bank details. The refund will only be made after deduction of 10%
of the total amount paid as administrative charges.

Seal & Signature

Payment details:
SBI collect reference no. Bank reference no. Date of payment Amount

(NOTE: Before making payment, kindly clear all queries about sample from the corresponding Instrument operator.)

Place:
Date: Seal & Signature

1. Name of contact person: ....................................................................................................................... ....................

2. Name of Supervisor: ....................................................................................................................... ....................

3. Name of Organization/Institute: ................................................................................... ........................................................

Sample submit to: In-charge SEM Facility, CIF, Indian Institute of Science Education and Research Bhopal, Bhopal By-Pass Road,
Bhauri, Bhopal (M.P.) 462066
Please superscribe the name of the facility on the envelop.
 4. Address: ....................................................................................................................... ....................

....................................................................................................................... ....................
5. E-mail: ........................................................................................................ ..................................

6. Contact no./ Fax. No.: ............................................................................................................................. ............

7. Sample Information:

S.No. Sample ID Sample description* Coating required? Imaging/EDS/Mapping†

(Powder/Pallet/Thin- (Yes or No)
film/Bulk)

*Only non-hazardous solid samples can be analyzed by SEM.

†
Mention whether only Imaging or EDS or both are required. There would be additional charges for EDS
analysis

9. Storage conditions/Hazards: .................................................................................................................... .......................

10. Invoice to be generated in the name of : .................................................................................

11. I f Invoice has to be generated in the name of Organization/Institute, mention GSTIN number of the
Organization/Institute: .................................................................................
12. Any other information: ...........................................................................................................................................

Sample submit to: In-charge SEM Facility, CIF, Indian Institute of Science Education and Research Bhopal, Bhopal By-Pass Road,
Bhauri, Bhopal (M.P.) 462066
Please superscribe the name of the facility on the envelop.