APPLICATION FOR FULL TYPE TEST REPORT TESTING SERVICES DEPT.

(ONE APPLICATION FORM FOR ONE OVERSEA Form No: TCQS/FOR/01-2/FTTR

MANUFACTURER) Issue No. : 1 Rev : 0
Page : 1 of 4
Effective Date : 24/08/2016

A. APPLICANT INFORMATION

1. Company Name & Address

2. Business Registration No. 3. Contact Person

4. Tel. No. 5. Fax. No 6. E-mail Address

7. Port of
Entry

B. PRODUCT INFORMATION
*Declared
Sampling Size/
Product Grade Standard HS Code Quantity Mill Cert. No.
Location Diameter
(MT)

(Please use Annex A if insufficient space)

*Quantity for 6 month of importation based on Contract Agreement/Letter of Credit/Purchase Order

C. INFORMATION ON OVERSEA SAMPLING

1. Oversea Manufacturer
& Address

Contact Person Product & Grade

Email Telephone No. Fax No.

2. Oversea Supplier &

Address (if any)

Contact Person Product & Grade

Email Telephone No. Fax No.

 APPLICATION FOR FULL TYPE TEST REPORT TESTING SERVICES DEPT.
(ONE APPLICATION FORM FOR ONE OVERSEA Form No: TCQS/FOR/01-2/FTTR
MANUFACTURER) Issue No. : 1 Rev : 0
Page : 2 of 4
Effective Date : 24/08/2016

D. THIRD PARTY INSPECTION BODY (TPIB), if any (leave blank if appoint SIRIM)
1. Name and Address of
TPIB

2. Contact Person 3. E-mail Address

4. Tel. No. 5. Fax. No.

6. Accreditation No.
(ISO 17020)

E. OVERSEA ACCREDITED LABORATORY (OAL), if any (leave blank if appoint SIRIM)

1. Name and Address of OAL

2. Contact Person 3. E- mail

Address

4. Tel. No. 5. Fax. No.

6. Accreditation No.
(ISO/IEC 17025)

F. PAYMENT
Payment need to be made in advance before services can proceed. Cheques are to be made payable to SIRIM QAS
International Sdn. Bhd. For other methods of payment kindly use the following details

RHB BANK BERHAD

Bank Details 16 & 18, Jalan Tengku Ampuan Zabedah D9/D,
Section 9, 40100 Shah Alam, Selangor, Malaysia

A/C NO: 21 – 2451 – 4008 – 6087

To facilitate confirmation on the bank transaction, please fax / email:

Payment a) bank in slip
Verification b) copy of cheque

Fax No: 603-55445886 (Siti Haslinda ) / slinda@sirim.my

I. CHECKLIST OF DOCUMENTS TO BE SUBMITTED BY APPLICANT

1) Application For Full Type Test Report – Both sampling & testing by SIRIM
Application Form Mill Certificate Contract Agreement / Letter of Credit Purchase Order

2) Application For Full Type Test Report – Sampling by TPIB, Testing by SIRIM
Application form Mill Certificate Contract Agreement / Letter of Credit Purchase Order

Inspection Cert List of Inspection Scope

3) Application For Full Type Test Report – Sampling by TPIB, Testing by OAL
Application Form Mill Certificate Contract Agreement / Letter of Credit Purchase Order

Inspection Cert. List of Inspection Scope

Accredited Cert. List of Accredited Scope

 APPLICATION FOR FULL TYPE TEST REPORT TESTING SERVICES DEPT.
(ONE APPLICATION FORM FOR ONE OVERSEA Form No: TCQS/FOR/01-2/FTTR
MANUFACTURER) Issue No. : 1 Rev : 0
Page : 3 of 4
Effective Date : 24/08/2016

H.
COVENANT OF CONSIGNEE

I ___________________________________ have read and fully understood and agreed to abide by the ‘General
Information, Term and Condition Relating to Acceptance of Products for Testing’ and ‘Guideline for Importation of Goods
Into Malaysia Listed Under Custom (Prohibition of Imports) Order Amendment No 2 2009’.

Signature

Name I.C No.

Designation Date

Firm/Company Stamp

G. FOR INTERNAL USE – PAYMENT

1. Cash RM

2. Cheque/Bank Draft/Postal Order (Payable to SIRIM QAS International Sdn. Bhd.)

Cheque Amount RM Bank/Branch
No.

3. Credit Card: VISA / MASTERCARD / AMEX

Card No. Amount RM

JOB NO.

PAYMENT RECEIPT NO.

RECEIVED BY DATE RECEIVED

NAME SIGNATURE
 APPLICATION FOR FULL TYPE TEST REPORT TESTING SERVICES DEPT.
(ONE APPLICATION FORM FOR ONE OVERSEA Form No: TCQS/FOR/01-2/FTTR
MANUFACTURER) Issue No. : 1 Rev : 0
Page : 4 of 4
Effective Date : 24/08/2016

APPENDIX 1: DETAILS OF PRODUCT FOR FULL TYPE TEST REPORT APPLICATION

DETAILS OF PRODUCT FOR FULL TYPE TEST REPORT APPLICATION

*Declared
Sampling Size / Mill Cert.
No. Product Grade Standard HS Code Quantity
Location Diameter No.
(MT)

10

11

12

13

14

15

16

Remarks: