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1、委托检测协议书TESTING APPLICATION FORMSRIL-410-02委托书编号Application No.：注：为必填工程are required items样品库号Sample No.：委托方信息Authorizing Party Information受托方信息Authorized Party Information单元名称Applicant：单元名称Applicant：安科工程技术研究院北京联系人Contact Person： Tel.：/59电子邮件E-mail： Fax： Tel.：地址Address：北京市海淀区北四环中路229号海泰大厦1702室 Fax：开户行
2、名称：中国工商银行北京二里庄支行地址Address：账号：0200 240 7092 000 30682检测信息Test Information可附页样品名称Sample Name数量Quantity样品材质Sample Material样品状态Sample Status样品原号Original No.检测工程Test Items检测依据Test Standard： 注：如委托方未指定或未填写此项，那么视为同意受托方所选检测依据效劳类型及其他Service Required and Others效劳类型：(Service Type)：接收试样5个工作日内开展检测Performthetests
3、within 5 workdays after receiving the sample接收试样3个工作日内开展检测Performthetests within 3 workdays after receiving the sample加急效劳费为尺度效劳收费的150% 陈述形式：(Report Language)： 数量Quantity： 份 数量Quantity： 份注：假设不需要检测陈述，此项可以不勾选；首份检测陈述收费￥100，每多加一份检测陈述费用增加￥50，最终陈述收费为：100 + (数量(Quantity)1)50取陈述方式：(Report pick up)： 邮寄地址Mail
4、ing address：试毕样品处置方式Disposition of Post-test Sample：工期和费用The TimeLimitfor Project and TheExpenses预计完成日期Expected Completion Date： 年Y 月M 日D测试费用Test Expenses： 加工费用ProcessingExpenses：快递费用Express Expenses： 加急效劳费用Urgent Expenses：陈述费用Report Expenses： 总费用Total Expenses：备注重要提示：请您仔细阅读本单反面的根本条款。IMPORTANT NOTIC
5、E: Please read the basic terms on the back of thispaper carefully.委托方签字(Authorizing Party Signature)：受托方签字(Authorized Party Signature)：日期：年Y月M日D日期：年Y月M日D根本条款1. 委托方须包管送检样品的真实性、代表性及来源的合法性，并承当由此引起的全部责任。2. 委托方对送检样品中包含的任何或潜在危害，如放射性、有毒或爆炸性样品，应事先声明，否那么后果由委托方负责。3. 本协议书的 件、复印件均有效，受托方仅对来样负责，检测成果仅反映对该样品的评价，检测成
6、果的使用、使用所发生的直接或间接损掉，受托方不承当任何责任。4. 委托方如对陈述有贰言，可在获取陈述15日内向受托方提出复检要求，受托方视情况作出复检安排。假设复检成果与检测陈述成果一致，那么委托方需支付复检费用，假设复检成果与检测陈述不一致，那么由双方协商解决。被检样品经委托方自取或受托方邮寄后，委托方无权要求受托方复检。5. 委托标的目的受托方支付全部检测费用后，方可领取检测陈述。6. 本协议自双方签字或盖章之日起生效。7. 因本协议履行发生的争议或纠纷，由双方友好协商解决，无法达成一致的，任何一方可将争议或纠纷提交北京仲裁委员会仲裁。8. 本协议中英文不一致的以中文为准。SERVICE
7、TERMSAND AGREEMENTS1. The authorizing partyshould guarantee the authenticity, representative and legality of the sample, and assume the responsibility of the resulting.2. The authorizing party should prior statement that any known or potential hazards of the sample, such as, radioactive, poisonous o
8、r explosive, otherwise the consequence is responsible by the authorizing party.3. FACSIMILIES, COPIESofthisagreement are legally effective, authorized partyis justresponsible forthesample(s)receivedonly, and does not undertake any responsibility of direct or indirect losses from the use of test resu
9、lts.4. The authorizing party could ask for are-inspectionrequirementwithin 15 days after obtain the report, has any objection to the report, authorized party make the re-inspection arrangementas appropriate.If the re-inspection result is consistent with the test report, then the authorizing party sh
10、ould pay the re-inspection expenses, if the re-inspection result is inconsistent with the test report, then negotiation by both sides.After the authorizing party get the tested sample(s)by self-pick up or by mailed from the authorized party, the authorizing party has no right to require the re-inspe
11、ction.5. The authorizing party could get the test report after pay all the expenses.6. Thisagreementisvalidating from thedayofsigningbyboth parties.7. Controversy or dispute arising out of performance of this agreement, should settledamicably through negotiation by both parties, if unable to agree,
12、any party will place controversy or dispute submitted to Beijing Arbitration Commission for arbitration.8. If there is any inconsistency or conflict between the English and Chinese versionsin theagreement,the Chinese version shall prevail.9. 内容总结10. （1）委托检测协议书TESTING APPLICATION FORMSRIL-410-02委托书编号Application No.：注：为必填工程are required items样品库号Sample No.：重要提示：请您仔细阅读本单反面的根本条款
