Intention to have sample analysed

(See rule 7)

To 
…………………..
………………….

The sample of ………………………….. which has been taken today, the ………………………. day of ………………20……… from [Here write the name of the officer/authority from whom sample was obtained] …………….. for analysis.

The same was in a condition fit for analysis as reported below.

I further certify that I have analysed the aforementioned sample on …………. and declare the result of the analysis to be as follows :

[Here write full details of analysis and refer to method of analysis]
………………………………………………………………………………………………………..
………………………………………………………………………………………………………..
 
The condition of seals, fastening of sample on receipt was as follows :
………………………………………………………………………………………………………..
………………………………………………………………………………………………………..
Signed this …………………………………… day of …………………………… 20…………..
Address …………………………………..					     

Signature
(Government Analyst)