INSTITUTE FOR DEINSTITUTE FOR DESIGN OF ELECTRICAL MEASURING INSTRUMENTS, MUMBAI
MINISTRY OF MSME, GOVT OF INDIA
S.T.TOPE MARG, CHUNABHATTI, SION P.O. MUMBAI – 400 022
MAHARSHTRA, INDIA
TEL: 022 -24050301/2/3/4. FAX: 022 -24050016
Page 1 of 2
FF-LAB-38
CUSTOMER REQUEST FORM (CALIBRATION)
For Office use only
Work Order No.: WO/ / /21-22
Date:
Customer Details
Customer/ Applicant
Name :
Address of Customer/
Applicant
Billing Address:
(If other than above)
Name & Address required
in Calibration Certificate:
(If other than above)
Representative Name with
Designation/ Department:
Phone No.:
Email ID.:
Fax. No.:
Mobile No.
GSTIN No:
PAN No:
SAC Code:
MSME Registration No.
Purchase Order No.
Delivery Challan No:
dt.
Services required
Calibration
Equipment / Product Details
Name of Equipment
Sr. No.
Model
No.
Id. No.
Range
of Calibration
Accuracy
Make
INSTITUTE FOR DEINSTITUTE FOR DESIGN OF ELECTRICAL MEASURING INSTRUMENTS, MUMBAI
MINISTRY OF MSME, GOVT OF INDIA
S.T.TOPE MARG, CHUNABHATTI, SION P.O. MUMBAI – 400 022
MAHARSHTRA, INDIA
TEL: 022 -24050301/2/3/4. FAX: 022 -24050016
Page 2 of 2
FF-LAB-38
Equipment / Product Details
Name of Equipment
Sr. No.
Model
No.
Id. No.
Range
of Calibration
Accuracy
Make
Note: Validity of Calibration required: Yes OR NO
Accuracy: Please attach separate sheet, if required
Calibration Charges …………………….………. GST Amount …………………….… TDS (If deducted)…………………… .
Total Amount ………………………………………………………………………………………………………………………………………...
Cheque/ Demand Draft no. ………………dt. …………. Name of the Bank………………………… Branch.……………..
RTGS/NEFT/UTR No………………………………………………………………………………………………………………………………..
IDEMI Bank Details: IDBI Bank Ltd., 12-16, Sunny Estate, Sion Trombay Road, Chembur, Mumbai – 400071
Account no.: 018102000013350 Type: Current A/C, IFS Code: IBKL0000018)
IDEMI GSTIN :27AAAAI0012M1Z1 IDEMI PAN No:AAAAI0012M
SAC Code: Signature& Name of the Customer
……………………………………………
NOTE:
1. Please bring the filled form while submitting the Instruments for Calibration.
2. Calibration work will start after receipt of 100% payment in favor of IDEMI MUMBAI
3. Calibration certificate will be issued only on above details. No correction or any amendment in
the Calibration Certificate will be made once it is issued.