(Entrepreneurship Development Center) / Registered office :100, NCL Innovation Park
Dr. Homi Bhabha Road
Pune- 411008, India
Phone: +91-20-25865877/ 64011026
Fax:+91-20-25865879
Web:
Email:

Application Form: Analytical Services Package

(Revised: 15May, 2018)

VC/Analytical/2018-19/ Date:

1. Applicant information
1.1 / Applicant full name
1.2 / Name of company
1.3 / GST Registration No. / GST Registration State
1.4 / Affiliation/ profession
1.5 / Full postal address for correspondence
1.6 / Phone
1.7 / Email
2. Application for Discounts
2.1 / I wish to apply for the following discounts:
Residents of dedicated lab spaces at Venture Center
Incubatees of Venture Center's Lab2Mkt program and Proof-of-concept projects associated with Venture Center
CSIR-NCL scientists and students; Start-ups with substantial NCL related participation (know-how, staff, students, alumni)/ VC related participation (alumni)
Not-for-profit companies, Educational and research institutes; Social enterprises
2.2 / Please attach any attachments to support your claim for discounts (if required)
3. Application for services
Service Code / Equipment / Number of Samples / Required dates & duration
TA-01 / DSC
TA-02 / STA 6000
CG-01 / HPLC
CG-02 / GC
CG-03 / Quantitative Analysis for GC /HPLC
SS-01 / FT-IR
SS-02 / Flame Spectrometer - UV/NIR; STS Micro Spectrometer-UV/NIR; Spectrofluorometer
SS-03 / Particle Size Analyzer
SPS-01 / Microwave Digestor

4. Sample Details

4.1 / Sample Details
4.2 / Does it involve hazardous chemicals? (Yes/No)
4.2.1 / If yes, brief description
4.3 / Does it involve hazardous biological materials? (Yes/No)
4.3.1 / If yes, brief description
4.4 / Procedure Requested

It is hereby declared that the undersigned has read and understood the terms and conditions of Venture Center’s Analytical services package and accepts the same.

The undersigned authorized representative of the applicant also declares that all the information given herein above is true and correct to the best of his personal knowledge and belief and also understands that in the event of any information found to be untrue or incorrect, the contract of the said services is liable to be terminated forthwith.

The application form once submitted cannot be cancelled and the applicant is liable to pay the charges towards the services applied for.

Payment Terms:

  • All the charges towards the services applied are advance payments to be paid against the invoice raised.
  • Payment Mode: Cheque/Draft/Cash, Please note that, cheque to be drawn in favour of "Entrepreneurship Development Center"
  • Payment to be made by demand draft or cheque payable at per in Pune.

For Office Use Only / For and on Behalf of
Total charges (Rs.) / (Name of the Company)
Extra Hrs
Discount @
Net Charges (Rs.) / (Name of the authorized signatory)
Taxes if applicable / Designation

The Entrepreneurship Development Center (service mark: Venture Center) is incorporated under Section 25 of the Companies Act, 1956 (India). Venture Center is a member of the Indian STEP and Business Incubator Association (ISBA) and the National Business Incubation Association (NBIA). CIN-U73100PN2007NPL129455