SRA 2026MF05R1 Sample Receipt Acknowledgement Fill out this form within 2 days of receiving your PT sample. If we don’t receive this within 2 days, we will assume the sample is intact and no complaints will be accepted later. For any issues, report immediately via email: pt@envirocare.co.in All fields are mandatory. PT Round(Required)2026MF05R1Please select appropriate PT code.I received this PT item on(Required) DD dot MM dot YYYY Lab Code Allotted(Required)Please enter a number from 0 to 25.Lab Code is allotted in Hard Copy in PT Item Box Use Lab code in all future correspondencesCondition of the received PT item(Required)Intact and fit for analysisDamaged or Not FitPlease submit the picture of PT item received(Required)Max. file size: 512 MB.Ensure the picture has the sample forwarding letter showing your lab code and PT item in a single frame.Describe the damageYesNoNot ApplicablePhotographic Evidence of the Damaged PT item Drop files here or Select files Max. file size: 512 MB. Remarks if any:Name of Participating Laboratory/ Organization:(Required) Name of the contact person(Required) First Last Designation(Required) Email(Required) Mobile No.(Required)Consent(Required) I confirm the information provided in this form. Correspondence Information All correspondence should be done by the key person/contact person as per the registration form. For any clarification, email us at pt@envirocare.co.in.
