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MS Triple TOF

This document is a requisition form for ESI-MS Triple TOF at the Advanced Technology Platform Centre, detailing the necessary information required for sample submission. It includes sections for user details, sample information, payment details, and an undertaking for safety and acknowledgment. Users must follow specific instructions and provide complete information to ensure proper processing of their samples.

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Satyajeet Biswal
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4 views

MS Triple TOF

This document is a requisition form for ESI-MS Triple TOF at the Advanced Technology Platform Centre, detailing the necessary information required for sample submission. It includes sections for user details, sample information, payment details, and an undertaking for safety and acknowledgment. Users must follow specific instructions and provide complete information to ensure proper processing of their samples.

Uploaded by

Satyajeet Biswal
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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Advanced Technology Platform Centre

Regional Centre for Biotechnology, Faridabad


NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway,
P.O Box-3, Faridabad-121001, Haryana, India
Requisition Form for ESI-MS Triple TOF
Phone : 0129-2848631

For Office Use Only


Lab code_______________________________ MR code____________________________________
Remarks___________________________________________________________________________

User Name________________________ Principal Investigator____________________________


Contact No.____________________________ Email ID__________________________________
Name of Institute/Industry____________________________________________________________
Postal Address______________________________________________________________________
Purchase Order No._____________________ GST No.__________________________________
Fee Remittance Details___________________ Additional Information______________________

IMPORTANT INSTRUCTIONS
1. Kindly provide your sample with completely filled sample submission form, duly signed by
your PI/Person-in-charge.
2. It is advised to follow SOPs for the upstream experiments, in order to get good quality data and for
better troubleshooting, if required.

#Please fill the following information below and use extra sheet wherever required.
1. Sample information:
Peptide mass finger Printing (PMF) / Small synthetic molecule / Metabolite / Intact mass analysis of
Macromolecule / Quantitation( iTraq / SILAC / TMT / AQUA / Label Free)/PTM analysis/Mutation
validation/Other (Please describe in brief).
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2. Complexity of Samples: 1D Digest/ 2D Digest/Pull Down/ whole cell digest/Ion exchange
fractionation/if other please describe_____________________________________________________
__________________________________________________________________________________
3. Enzyme used:
__________________________________________________________________________________
4. Stain used for visualization (if in-gel digestion):
__________________________________________________________________________________
5. Total number of samples:
__________________________________________________________________________________
6. Other sample details to be filled in the succeeding table-

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6. Sample details (Please fill all the r equir ed sections):

S. No. Sample Name/Code Molecular Weight Origin

*For more number of samples, please attach an extra sheet in similar format, duly signed by your PI/
Person-in-charge.

7. Additional information, if any: ______________________________________________________


___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

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PAYMENT DETAILS
(Payment to be done in advance through NEFT)

Bank account information for funds transfer:


Account Name Executive Director, Regional Centre for Biotechnology (ATPC)
Account No. 349301000047
Bank Name ICICI BANK, Faridabad Branch, THSTI Building
IFSC Code: ICIC0003493
MICR Code 110229278

GST No.: 06AAAAR9016J 1ZG

Total Amount Paid________________________ Transaction Reference No.___________________________________

Date of Transaction________________ Payment Receipt Required in Favor of________________________________

Name and Signature of the Payer______________________________________________________________________

UNDERTAKING

I/We undertake to abide by the safety rules, sample preparation guidelines and take all the precautions during study of
samples towards my/our personal safety and safety of the operator and equipment. I/We submit the sample in good faith and
ATPC will not be held responsible for loss/damage due to reason(s) beyond its control. I/We shall duly acknowledge the
ATPC in all the publications/patents emerging out of the results from the studies at ATPC, thereafter in journals or elsewhere.

Statement for Acknowledgement–


“This research work was carried out in part at the Mass Spectrometry Facility of the Advanced Technology Platform Centre
(ATPC) which is managed by the Regional Centre for Biotechnology (RCB), and is funded by the Department of
Biotechnology (Grant No. BT.MED-II/ATPC/BSC/01/2010).”

Date

Signature of User Signature of PI/Person-In-Charge

FOR OFFICE USE ONLY (ATPC FACILITY)

Date Received_________________________________________ Stored at________________________________________

Received by___________________________________________ Signature_______________________________________

Signature of Approving Authority__________________________________________________________________________

FOR OFFICE USE ONLY (ACCOUNTS)

Amount Received_______________________________________________________________________________________

Name and Signature of person-in-charge, Accounts_____________________________________________________________

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