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Borang NMR

This document is a sample submission form for the Nuclear Magnetic Resonance Laboratory at a university. It outlines 6 general rules and requirements for sample submission including: 1) providing accurate information, 2) being notified of bookings by email, 3) completing the application form with a valid research vote number, 4) preparing dry, pure samples of at least 20mg for certain tests, 5) directing inquiries to the listed science officers, and 6) collecting samples within a week of results or they will be discarded. The form then requests information about the applicant, supervisor, payment details, samples, and tests requested.

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52 views1 page

Borang NMR

This document is a sample submission form for the Nuclear Magnetic Resonance Laboratory at a university. It outlines 6 general rules and requirements for sample submission including: 1) providing accurate information, 2) being notified of bookings by email, 3) completing the application form with a valid research vote number, 4) preparing dry, pure samples of at least 20mg for certain tests, 5) directing inquiries to the listed science officers, and 6) collecting samples within a week of results or they will be discarded. The form then requests information about the applicant, supervisor, payment details, samples, and tests requested.

Uploaded by

Affifah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form Num.

UIRL/F/135
Version 2/2021
PUSAT PENGURUSAN MAKMAL
Effective Date 1/05/2021
UNIVERSITI (PPMU) Equipment 400 MHz
Sample Serial No.
NUCLEAR MAGNETIC RESONANCE LABORATORY
SAMPLE SUBMISSION FORM
General Rules and Requirement:
LIQUID
1. All information provided should be true
2. Booking will be notify/updated by email
400 MHz
3. Booking procedure
a. Complete the application form including valid research vote number
b. Submit the completed application form to the lab
4. Sample Condition & Preparation
a. PPMU has the right to cancel any analysis if the sample is suspected to have high risk on the safety of the operator or can cause damage to
the instrument during the analysis. The cost of damages will be borne by the customer.
b. The sample must be dried, pure and known the solvent (please state the solvent for each sample)
c. 1H test, meanwhile, 20mg for 13Carbon test and others.

d. Samples shall be delivered in small glass containers, sealed and labelled.


5. All enquiries regarding the instrument should be forwarded to the Science Officer (Officer (Mr. Rasyidi Abd. Mubin, email: rasyidimubin@utm.my)
or Assistant Science Officer, (Mr Muhd Hasni Bin Rosli, email: muhammadhasni@utm.my.)
6. Important: Sample must be collected after the result is released within one week, otherwise the sample will be discarded.

1.

Name of Applicant

Status of Applicant Undergraduate Master PhD Research

Student Matric No.

Faculty/ Department

Hand Phone No. & Email

2. SUPERVISOR DETAILS (for internal applicant and academic institution only)


Name of Supervisor

Staff ID No.

Faculty/ Department

Hand Phone No.

Email

Mode of Payment Cash EFT Log card Invoice

Research Vot No.


(e.g.: Q.J091600.24C3.01D32)
Payment using Invoice
Balance of V29000

Signature & Official Stamp

3. SAMPLE & ANALYSIS INFORMATION

Total No. of Sample

Test Solvent Type Properties


Name of Sample 1H,13C, CDCL3, DMSO, Organic / Inorganic/
All Dept, COSY, Halogenic/ Non-
Methanol-D4, Ethanol- polymer
HMBC, HMQC Halogenic
D4, D2O, Acetone-D6
i)

ii)

iii)
Sample Information
Please state the hazards of the
sample. Ex: Toxic

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