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This form should be filled up, printed, signed, and brought together with the samples to the Technology Centre.
Official project name (to be filled by FIMM Technology Centre):
__________________________________________________
Please, see DNA / RNA requirements at FIMM website.
Plate details are filled at the end of this form
______________________________________________
Name and signature of the person bringing the samples
Name and signature of the person receiving the samples
Date : __________________________________
Name and signature of the person picking up the samples
Name and signature of the person returning the samples