toy testing requisition form 玩具测试申请表 - intertek (hong kong).docVIP

Restricted Hazardous Substances Testing Requisition Form 測試申請表 Form No. Applicant’s Company Name 公司名稱: Official Use Only Address 地址: Rpt. No. Contact Person 聯絡人: E-mail電郵: A/C No. Telephone電話號碼: Fax傳真號碼: Dept.部門: RR Date Company Name Address shown on Test Report (if different from the Co. Name above) 報告頁首之公司名稱及地址 (若同上，則不用填寫) : Sample Description / Item Name樣品名稱: No. of Sample Submitted樣品數量: Item / Ref. / Model / Style No.*樣品型號: Goods Exported to產品運往: Country of Origin 原產地: Supplier 供應商 / Vendor 賣家/ Manufacturer 製造商* : Buyer Name買家: Test(s) Required: (Please tick appropriate boxes) 測試項目名稱 (請在適當空格內 “”) RoHS Others Cadmium 鎘 Chlorinated paraffins 氯化石蜡 PCBs 多氯聯苯 Lead 鉛 Mirex 滅蚊靈 Asbestos (石棉) Mercury 汞 PCN 多氯化萘 TBBP-A-bis 四溴雙酚 Hexavalent Chromium 六價鉻 PVC 聚氯乙烯及其混合物 PBBs 多溴聯苯 AZO compounds-22 項偶氮 PBDE 多溴聯苯醚 Formaldehyde 甲醛 Toxic Element in Packaging Material 包裝材料重金屬 94/62/EEC Organic tin compounds (TBT TPT) 有機錫化合物 (三丁基錫和三苯基錫) Other Tests (Please specify) 其他 (請註明)： Additional information to Intertek (1) HKEAME Members ? Yes No (2) If your test sample complied with RoHS Requirements, would you accept to provide your company information, test sample information (such as sample description , test report number) to HKEAME’S RoHS database ? Yes No For details of the test method used, please refer to the information at Intertek Website. /resources/jobrequestforms/?lang=en Select Country: Hong Kong and click Go button Service Required服務要求: Regular普通 Express (40% Surcharge) 快 (40% 附加費) Shuttle (100% Surcharge) 特快 (100% 附加費) Report Delivery Service報告送遞服務: Yes需要 No不需要 Return Sample退回樣品: Yes需要 No不需要 Is this a retest是否重試: Yes是 No否 If Yes, Please state previous report no. 如是請填上舊報告的號碼: We request for the above tests and agree that all testing will be carried out subject to INTERTEK TESTING SERVICES HONG KONG LTD’s scale of charges as set forth in their latest price list of