TEST APPLICATION FORM – HARDGOODS

Company Name :
Address :      
Contact Person :       E mail Address :
Contact No. : GSTN No. :
Sample Description :       Fax No. :      
Fiber Content / Material
: No. of Samples :
(Metal: Plated/ Unplated)
Product Type / End use :       Colour :      
Order No. :       Buyer :      
Style No. :       Agent :      
Country of Origin :       Supplier :      
Country of Destination :       Season :      
Service Required : Regular (5 – 6 working days) Express* (3 - 4 working days) Urgent*# (24working hours)
Method to be used : AATCC/ASTM ISO BS EN DIN Others:      

Test(s) Required:
Candle and Candle Accessories Environmental Tests Chemical Test
Resistance to Corrosion
Container Temp test (Candle Size- ______) (Salt Concentration – 1% or 5 % Lead in surface coating
Test Duration – 24 / 48 / 72 or __Hr.)
Humidity Exposure
Candle Burn Test (Temp.______ & RH _______ Cadmium in surface coating
Test Duration - ________Hr)
Thermal Shock Heat/Oven Exposure Total Lead content
Effectiveness of Annealing Cold Exposure Total Cadmium content
Products Safety Labels And Warnings Resistance to Extreme Temp Nickel spot test
Candle sooting behaviour Other Test Nickel release test
Flammability Abuse test Stability, Heavy Metal analysis-ASTMF 963 / EN 71-3
Cookware / Serveware Drop test, Polycyclic Aromatic Hydrocarbon (PAH)
Capacity Measure Moisture content, Reach-SVHC Testing
Handle strength – Loaded Cross cut adhesion test Azo
Stain resistance Flammability of solids Phthalate
Effects of Handwashing Bursting Strrength Organotin Compounds
Dishwasher safe GSM Formaldehyde
Microwave Exposure Flame Retardent
Food Contact Materials (Refer Attached
Oven safe Questionnaire on Page No. 2)
Thermal shock resistance Leachable lead and cadmium
Specific Migration of Heavy metal / Primary
BS EN 12983-1 Aromatic Amine / BPA
ISO 8442 – 1 & 2 Overall Migration
PCP
Metal Composition
BPA Content
Color Migration

If others, please specify .......................................

..............................................................................
Sample Return : Yes No Report Recipient Applicant Payer
Invoice Recipient Applicant If other, please provide the following information:
Payer’s Name : Contact Person :
E-mail Address : Contact No. :
Billing Address: :      
THE ABOVE REQUESTED TESTS ARE SUBJECT TO THE TERMS & CONDITIONS SET FORTH BY THE RESPECTIVE TÜV SÜD LABS.
Authorized Signature / Compony Stamp / Date: Checked & Received by TÜV SÜD / Date & Time:
     
 For applicable tests only # Samples must be received by 10:30 A.M

Laboratory: Regd. Office:

TUV SUD South Asia Pvt Ltd TÜV SÜD South Asia Pvt. Ltd.
373, Udyog Vihar, Phase -II, Sector-20, Off. Saki Vihar Road,
Gurgaon – 122016 Saki Naka, Andheri (East),
Telephone: +91-124- 6199699 Mumbai – 400072. India
FAX : +91-124-6199599 [email protected]

Prepared By: Sourav Bhattacharya Reviewed & Issued By: Krishna Deori Approved By: Anuradha Dhamija
Document No.: LAB_F(H)_002 Issue No.: 01 Issued On: 25/01/2018 Revision No.: 00 Revision Date: --/--/--- Page 1 of 3
 TEST APPLICATION FORM – HARDGOODS
(FCM QUESTIONNAIRE)

Name
Address
Contact person
Telephone
E. Mail
Sample Name Product type
Country of origin
Country of
Destination

Material List (Pl. tick whichever is applicable):

Ceramics Adhesives Others 1 (Pl. specify)
Glass Paper Others 2 (Pl. specify)
Plastics Wood Others 3 (Pl. specify)
Polypropylene Silicones Others 4 (Pl. specify)
Poly ethylene Ion exchange resins Others 5 (Pl. specify)
PVC Metals and alloys Others 6 (Pl. specify)
Paper board Rubber Others 7 (Pl. specify)
Paper board with wax Cork Others 8 (Pl. specify)
Varnishes and coatings Textile Others 9 (Pl. specify)

End use :
(Pl. tick whichever is applicable)

Aqueous, non acidic foods Oils, fats and processed dry Others 2 (Pl. specify)
foods
Aqueous, acidic foods Non acidic foods (High fat & Others 3 (Pl. specify)
moisture)
Alcoholic beverages less Acidic foods (High fat & Others 4 (Pl. specify)
than 10% moisture)
Alcoholic beverages above Dry processed food without fat Others 5 (Pl. specify)
10%
Others (Pl. specify)) Others 1 (Pl. specify) Others 6 (Pl. specify)

Contact time
Contact temperature

Regulation:
(EC) 10/2011 UK Others 2 (Pl. specify) IS 10148
Italian decree, 21 Mar USA Others 3 (Pl. specify)
1973
Germany, LFGB Others (Pl. specify) Others 4 (Pl. specify)

Laboratory: Regd. Office:

TUV SUD South Asia Pvt Ltd TÜV SÜD South Asia Pvt. Ltd.
373, Udyog Vihar, Phase -II, Sector-20, Off. Saki Vihar Road,
Gurgaon – 122016 Saki Naka, Andheri (East),
Telephone: +91-124- 6199699 Mumbai – 400072. India
FAX : +91-124-6199599 [email protected]

Prepared By: Sourav Bhattacharya Reviewed & Issued By: Krishna Deori Approved By: Anuradha Dhamija
Document No.: LAB_F(H)_002 Issue No.: 01 Issued On: 25/01/2018 Revision No.: 00 Revision Date: --/--/--- Page 2 of 3