Section a General Particulars 7 X 7

Section a General Particulars 7 X 7

23rdCORROSIONAWARENESSAWARDS 2017

ApplicationForm

Excellent Public / Private Sector Laboratory

CONTENTSOFAPPLICATION

Section / Details / Sheets / Remarks
(to be filled in by NIGIS)
A / Applicant's Letter
NIGIS Form - General Particulars
Applicant's Essential Enclosures
A01 / Proof of Registration / Incorporation of Laboratory
A02 / Recommendation Letters
A03 / Resume (max 300 words)
B / NIGIS Form -Confidential (tobefilled inby the authorized person withoutmentioning name ofLaboratory anywhere inthis Form)
B / 1 / Objectives
B / 2 / Technical Competence
B / 2.1 / Certification / Approval of Laboratory / Tests
B / 2.2 / Manpower / Equipment & Facilities
B / 3 / Experience - Last 5 years
B / 3.1 / Test Conducted and Research Projects carried out
B / 4 / Publications & Special Contributions (Last 5 years)
B / 5 / Corrosion Awareness/Promotion Activities or Awards
(Last 5 years)
B / 5.1 / Memberships of Corrosion Institutions /Societies
B / 5.2 / Participation in Corrosion related Conferences / Seminars/Events
B / 5.3 / Awards for Contributions to Field of Corrosion/etc.
B / Applicant's Enclosures (with Enclosure Nos. written on all pages
and Applicant 's name written only on top of first page of Enclosure)
B / 2.1 / B / 01 / Copy of Certificate of Certifying / Approving Authority
B / 2.2 / B / 02 / List of Test Equipment / Facilities
B / 3.1 / B / 03 / List of Test and Projects carried out
B / 4 / B / 04 / List of Publications
B / 4 / B / 05 / List of Technical Research Contributions
B / 5.1 / B / 06 / List of Membership of Corrosion Institutions / Societies
B / 5.2 / B / 07 / List of Corrosion Conferences / Seminars Participated
B / 5.3 / B / 08 / List of Awards received for Contribution to Field of Corrosion

23rdCORROSIONAWARENESSAWARDS 2017

ApplicationForm

Excellent Public / Private Sector Laboratory

ApplicationNo. (To be filled by NIGIS)......

SECTION– A : GENERAL PARTICULARS

  1. AWARDAPPLIED FOR

  1. GENERAL

Nameof Laboratory
Laboratory / Public / Private
Address
City / State
Pin:
Phone / Fax
Mobile
Email
Person Submitting Application
Name
Designation
Address
City / State
Pin:
Phone / Fax
Mobile:
Email:
Preferred Address for Communication / Lab / Person
Date of registration / Incorporation
  1. ESSENTIALENCLOSURES
/ Enclosed / Yes / No
A-01 - Proof of Registration / Incorp
A-02 - Recommendation
Letters
A-03 - Resume
(max 300 words)
I confirm that all information given and enclosed is true to best of my knowledge.
Signature / Date

23rdCORROSIONAWARENESSAWARDS 2017

ApplicationForm

Excellent Public / Private Sector Laboratory

SECTION- B: CONFIDENTIALPARTICULARS

(To be filled in by applicant without mentioning his / her name anywhere)

  1. OBJECTIVES (According to Memorandum /Articles of Establishment of Laboratory)

SN / Objectives / Yes / No
ONLY INTERNAL / OTHER CUSTOMERS
1 / Monitoring, Testing , Evaluation of performance and quality of materials
2 / Research and Development related to
Objective-1 & Corrosion Control
3
4
5
6

2. TECHNICALCOMPETENCE

2.1Certifications /Approvals of Laboratory / Tests

SN / MainTests / Standard / Certified /Approved by
InternationalAuthority / NationalAuthority
1
2
3
4
5
6

2.2Manpower / Equipment & Facilities

Key Personnel / Main Equipment
SN / Designation / Nos. / Education / Experience, years / Name / Make / Quantity / Age in years
Minimum / Maximum / Minimum / Maximum
1 / Format for presentation of details to be given under
Enclosure B-02
2
3
4
5
6
  1. EXPERIENCE(Last 5 years)

SN / Details / In-House Projects / Public Sector Projects / Private Sector Projects
Number / Value, Rs / Number / Value, Rs / Number / Value, Rs
1 / Tests listed under Section 2.1 above
2 / Tests other than that listed under Section 2.1 above
3 / Research & Development Projects - Test Equip / Procedures
- Materials
- Corrosion
- Failure Analysis
- Others
4 / Works related to any other any Objectives
  1. PUBLICATIONS & SPECIALTECHNICALCONTRIBUTIONS (Last 5 years)

SN / Publications / SN / SpecialTechnical
Contributions / TestEquip& Procedures / Material
Performance / Corrosion
Control / Other
Details / Nos.
1 / Books / 1 / No. of Improvements
Full Books
Chapters in multi-author Books / 2 / No. of Developments
2 / Papers Presented in
National Conferences / 3 / No. of Indigenization
ForeignConferences
3 / Papers Published in / 4 / No. of Implementation
National Journals / Magazines
Foreign Journals / Magazines / 5 / No. of Patents
4 / Awards for Papers
National / 6 / Others, if any
Foreign
  1. CONTRIBUTION TO CORROSIONAWARENESS / PROMOTIONACTIVITIES ORAWARDS

5.1Membership of Corrosion Related Institutions / Societies

SN / Society / Institution / Organization / Membership / PresentOfficeBearer / PastPositions /
Specific Contributions
Type / From / To / Position Since Yr
1
2
3
4
5
6

5.2Participation inCorrosion Related Conferences / Seminars / Events (Last 5 years)

SN / Conference / Seminar/ Event / No. of conferences / Seminar / Events participated during the last 5 years as
Sponsor / Organizer / Invited Guest / InvitedSpeaker / Author / Delegate
1 / NIGIS- CORCON
2 / NACE International
3
4
5
6

5.3Awards for Contributions to Field of Corrosion & CorrosionAwareness Promotion (Last 5Years)

SN / Society / Institution / Organization / Year / Event & Place / Name of Award
1
2
3
4
5
6
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