FALIMS sample testing

Customer details

Complete this form before your sample is received for testing.

Name of customer Telephone number Initials of customer Name of company Address of company Title or position in company Email (optional)

I agree that payment will be made before the sample is taken for testing, and that payment will not be refundable.

Note: The laboratory shall keep confidential of all customer information disclosed by the customer, however these obligatiions shall not extend to any confidential information that is already in the public domain at the time of disclosure or comes within the public domain without the fault of the authority, or information required to be disclosed to a relevant institution by law or a court order.