Company Name *
Company Address *
Manufacturer/OEM Details *
Contact Person *
Phone / Whatsapp No. *
Enter exactly 10 digits.
E-Mail ID *
Product/Test Sample Name *
Test Sample Description *
Test Sample Model # *
Test Sample Serial # *
Number of Samples to be Tested *
Test Condition *
Select Operational Non-operational As per Test Plan
Accessories Submitted along with Test Sample *
Action on Test Failure *
Select Continue test Stop test Repeat the test Customer decision
Test Sample Operation Type *
Select Electrical Pneumatic Mechanical Hydraulic
Test Sample Voltage Type: AC / DC *
Select AC DC Test Coupon
Test Sample Frequency *
Select DC 50Hz 60Hz 400Hz Test Coupon
Test Sample Voltage V *
Test Sample Current / Wattage A / W *
Test Sample Collection / Dispatch Method after test *
Select Customer pickup Courier dispatch Dispose off
Test Sample Details - Upload
Allowed: DOCX, PDF, XLS/XLSX, JPG/JPEG, PNG. Maximum 2 MB.
Test Report Required? *
Select Required Not Required Data Only Separate Reports for each Task
Statement of Conformity *
Select Not Applicable Environmental test Against Standard Against decision rule criteria
Conditions for Statement of Conformity *
Select Not Applicable Attached Decision Rule Criteria Environmental test Administered by a published by National International standard under scope of Envitest Lab Administered by a published by Legal / Regulatory / Customer / Organizations providing recognition Provided by the customer with valid technical details and decision rules (Please attach)
Statement of Conformity / Decision Rule Upload
Allowed: DOCX, PDF, XLS/XLSX, JPG/JPEG, PNG. Maximum 5 MB.
Test Standard / Specification Type *
Select International / National Standard Derived / Institutional Specification Customer-Specific / Customized Specification
Test Standard / Method / Procedure / Clause *
Test Standard / Method / Test Plan Upload
Allowed: DOCX, PDF, XLS/XLSX, JPG/JPEG, PNG. Maximum 5 MB.