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1、E注：栏目为委托单位必填项目 Note: Items marked withare mandatory 委托单编号(Application No.): 委托单位中文名称(Client in Chinese)：委托单位英文名称(Client in English): 付款单位名称(Company of payment)： (付款单位名称为发票抬头，请准确填写。The invoice title is the Company Name of Payment, please complete accurately.)开票种类(Type of invoice)：普通发票(General invoice
2、) 专用发票(VAT special invoice) 联系人(Contact Person)： 电话(Tel)： 传真(Fax)： 电邮(E-mail) ：地址(Add)： 邮编(Post Code): 样品信息(Sample Information)样品名称(Sample Name)： 样品英文名称（In English）： 样品型号(Model No.)：产品制造商名称（Manufacturer）：买家名称（Buyer）：镀层(Clad) 基材(Substrate) 混测(Mix testing) 整体均一材质(Uniform composition throughout)样品编号(Sa
3、mple ID)(由实验室填写Fill in by lab)样品描述(Sample Description)：检测/测试项目及方法(Test Items and methods) RoHS六项：铅及其化合物（Lead and its compounds）；镉及其化合物（Cadmium and its compounds）；汞及其化合物（Mercury and its compounds）；多溴联苯（PBBs）；多溴联苯醚（PBDEs）请选择检测/测试方法：IEC62321:2008；EPA Method；SJ/T 11365-2006六价铬化合物（Hexavalent chromium com
4、pounds）请选择检测/测试方法：IEC62321:2008；ISO3613；EPA3060&EPA7196A；SJ/T 11365-2006备注：Cr（）六价铬 如选用ISO3613，须提供样品中镀层重量或表面积，最好同时提供基材和镀层的材质以及镀层的厚度。Note: if ISO3613 is to be used for Cr（）, the weight or surface area of the sample clad must be provided. It is better to provide the description of clad material and sub
5、strate material and the thickness of the clad layer as well.XRF； 邻苯二甲酸酯Phthalates（6项）； 邻苯二甲酸酯Phthalates（16项）； 卤素（F/Cl/Br/I）；多环芳烃 PAHs； PFOS/PFOA； 其他项目检测/测试依据(Test standard)申请人同意采用谱尼测试使用的检测/测试方法(The applicant agrees to adopt the testing methods used by Pony Test) 申请人要求采用指定的检测/测试方法(The applicant requi
6、res the use of the designated testing methods): 备注(Remarks)：服务类型及其他(Service Required and Others): 标准服务（Regular Service）: 57个工作日（5-7 business days）； 加急服务（Expedited Service）:3.5个工作日，加收40附加费 （3.5 business days, 40% surcharge)； 特急服务（Express Service）:1.5个工作日，加收100附加费 （1.5 business days, 100% surcharge）。请
7、选择报告形式 (Report language): 英文报告(English); 中文报告(Chinese) （任选一种，如需多选加收200-500元 You may select any one of them; if more than one is selected, additional fee RMB200-500 is to be charged）取报告方式及要求（Report pick up and requirements）:自取(Self pick-up) ; 国内EMS(Domestic EMS); 国际EMS (International EMS)按重量及地区收费(Cha
8、rge according to weight and distance) 申请CQC RoHS认证证书(Apply for CQC RoHS certificate) 原RoHS证书号(Number of existing RoHS certificate ): 大致完成时间 (Estimated finished date）：年(Y) 月(M) 日(D) 16:30以后 费用(Charge)单价（Unit Price）： 加急费用（Express Price）： 总费用（Total Price）： 实收费用（Actual Price）：请委托单位仔细阅读本委托书背面的条款，正面与背面的内容
9、均系本委托书的组成部分。委托单位的签字表明已看过并理解委托书背面条款，双方同意履行。（The Client shall read the clauses as showed on the back of this letter of commitment. All contents on the front and back sides will form the full contract. Once signed by the Client, it will be deemed that the client has understood the clauses on the back a
10、nd the two parties agree to carry out them.）委托单位声明：对样品及相关信息资料的真实性负责，并同意本协议背面“双方约定条款”，保证样品到达谱尼测试1个工作日内支付费用。 (Statement of the Client: to be liable for the truth of the sample and the related information and documents,agree on the back of this letter of commitment “clauses as agreed by the two parties
11、” and ensure to pay the test charge within 1 business day after the sample delivered to PONY.)委托单位（盖章） 检测/测试单位（盖章）Client (Stamp) Test organization (Stamp) 授权代表（签字） 授权代表（签字）Authorized representative (Signature) Authorized representative (Signature) 申请日期 受理日期(Date) (Date) / 委托检测/测试协议书双方约定条款Clauses of
12、the Test Application Form as agreed by the two parties 1.委托单位对结果如有异议，于报告完成之日起十五日内向我单位书面提出，同时附上报告原件及预付复检费。If the trustor holds an objection to the result, the trustor shall propose a written objection to us within fifteen days after the completion of report, and present the original copy of report wi
13、th retesting fee paid in advance.2.委托单位办妥以上手续后，我单位将尽快安排复检，不可重复性实验不进行复检。We shall arrange the retest as soon as possible after the foregoing procedure has been duly conducted, and be immune from conducting the recheck of the unrepeatable test.3.如委托单位与样品生产单位不一致，委托单位需提供生产单位拥有样品初始所有权并同意送检的证明。If the trust
14、or is not the manufacturer, the trustor shall submit the certificate which demonstrate the manufacturer possesses the initial ownership of such sample and agrees the presentation of sample.4.我单位仅对来样负责，结果仅反映对该样品的评价，结果的使用、使用所产生的直接或间接损失，我单位不承担任何责任。We shall only be responsible for the presented sample. The result only reflects the evaluation of this presented sample. We shall be free from any liability arising from such result, or any direct or indirect loss incurred by usage of
