Customer Details (Fields Marked with ( * ) Are Mandatory)

Customer Details (Fields Marked with ( * ) Are Mandatory)


Microbial Identification

Sample Submission Form

Customer Details (Fields marked with ( * ) are mandatory)

Name of Scientist*
Name of PI*
(Principal Investigator)
Name of Institute*
Quotation Number* / No. Of Sample: / Rate/Sample:
Sample ID / Please mention if samples are in duplicates:
Billing Type* / A. Direct
B. Through Distributor
(If yes, please provide name of Distributor)
C. PO Based
(If yes, please provide PO Number)
Billing Address*
Phone No/Mobile No*
E-mail ID*
Note: Forms will only be accepted when an acknowledgment is made to your PI(Principal investigator) while sending an e-copy and marking a copy as cc to your PI. While sending the forms in hard copy format, please get it signed by your PI.

Undertaking :I hereby solemnly declare and undertake that all information furnished by me are true, correct and complete to the best of my knowledge and belief.

Name:

Date:Signature:

Sample Details
Service / □MID-S (Only Sequencing) □MID-C (Contig Generation)
□MID-R (Report generation with phylogenetic tree)
Sample Type / □Bacteria □Fungi □Yeast □Algae □Actinobacteria □Cyanobacteria
Culture / □Slant □Petriplate □Glycerol Stock □Bacterial Pellet □Fungal Mycelia
Sample Source / □Human □Animal □Soil □Sea □Other (please specify):
Culture Revival / □Fresh □1-week old □15 days old (Culture Revival date: )
Microscopic View / □Yes □No (Remarks)
Gram Testing / □Positive □Negative (Remarks)
Please specify in case of any other testing:
Physical Characteristics / Biochemical test (please specify):
Color of culture:
Appearance on Media (Uniform/Spread):
Growth Conditions
Temperature
Media / □YPD □PDP □Nutrient Agar □LB Media
□Nutrient Broth □Other (please specify)
If specific media is required, please provide constituents in powder form for 100 ml preparation per ml with description in table on Page:3
Time Duration
Additional Comments
Expected Organism
(if possible)
Primer Details / □16S Bacterial Universal Primers
□18S/28S/ITS(1-4) Fungal Universal Primers
□Cyanobateria specific Primer
□Any other (please specify)
(Forward Primer):
(Reverse Primer):

Media Description : (for preparation of media for 100 ml per sample)

Sr.No / Description / Quantity

Note : Xcelris Genomics does not accept pathogenic organism.

Sample Preparation Guidelines

A. Precautions: All the steps must be followed under sterile conditions, using gloves.

B. Media:All the culture media should be prepared 3-5 days prior inoculation of the micro-organisms and kept under 30-37°C, to see, any unwanted growth of micro-organisms.If the media does not show any unwanted growth within 3 days, use that media for further culture or sub-culture, whichever is desired.If the media showed growth, without any inoculation, discard all the media prepared during that lot using proper protocol.

For Bacteria
(16S Sequencing) / For Yeast
(26S or ITS 1&4, 2&3, 3&4 Sequencing) / For Fungus
(18S or 26S Sequencing) / For Algae
The bacterial colony must be sub-cultured 2-3 times before handing over for identification. The final plate, which will be given for identification must be streaked on the solid media, to ensure axenic culture,along with glycerol stock/s or Stab culture/s. / The yeast culture must be sub-cultured 2-3 times before handing over for identification. The final plate, which will be given for identification must be streaked on the solid media, to ensure axenic culture,along with glycerol stock/s. / The Fungal culture must be sub-cultured 2-3 times before handing over for identification. The final plate, which will be given for identification must be streaked on the solid media, to ensure axenic culture,along with glycerol stock/s. / The Algal culture must be sub-cultured 2-3 times before handing over for identification. The final plate, which will be given for identification must be streaked on the solid media, to ensure axenic culture,along with glycerol stock/s.
Note: For the bacterial culture belonging to anaerobic origin, only isolated DNA is/are required. For aerobic bacteria we require either DNA or micro-organism/s.

C. Other Information:

  1. Proper labeling: All samples must be properly labeled.
  2. Sample duplication: Samples should be provided in duplicate to avoid any transport loss.
  3. Media Details: Media description, if available, should be provided. Media description must be communicated to our technical team before dispatch of the culture, to avoid any delay of result. This is to avoid delay is result, if the specialized media is / are not available with us.

D. Type:

I. Bacteria: Aerobic / Anaerobic, Gram positive / gram negative, Actinobacteria.

II. Yeast: Type must be mentioned, whether, known, unknown or other details, like color or morphology.

III. Fungus: Type must be mentioned, whether, known, unknown or other details, like color or morphology.
IV. Algae: Type must be mentioned, whether, known, unknown or other details, like color or morphology.

Note: If possible please provide the image. Please provide the basic micro-biological staining techniques, etc.

Identification strategy for Fungus

/ Identification strategy for Bacteria

Address :Xcelris Labs Ltd, Old Premchandnagar Road, Opp Satyagrah Chhavani,Sattelite, Ahmedabad-380015, Gujarat,India

Tel : 079-66197702 ( Direct ) , Fax : 91-79-66309341, . E-mail ID:

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