ASPER PATERNITY SAMPLE SUBMISSION FORM

Ordering person
E-mail

PATERNITY TESTING

Tested person / Name*or sample code / Date of birth / Date of sample collection
ALLEGED FATHER
MOTHER
CHILD(1)
CHILD(2)
CHILD(3)
CHILD(4)

PATERNITY TESTING FOR TWO ALLEGED FATHERS

Tested person / Name* or sample code / Date of birth / Date of sample collection
ALLEGED FATHER(1)
ALLEGED FATHER(2)
MOTHER
CHILD(1)
CHILD(2)
CHILD(3)

OTHER BIOLOGICAL RELATIONSHIPTESTING

Alleged relationship / Name* or sample code / Date of birth / Date of sample collection

* - Name is optional

Please get acquainted with the following terms and conditions of biological relationship testing and confirm your approval for the testing.

I understand that:

- the genetic data processed during the testing is a delicate personal data and hereby I give my informed consent to processing this data; and that

- I am personally responsible for taking the sample following the instructions of sampling. Asper Biogene is not responsible for the failure of the test due to improper sampling or poor sample quality; and that

- I am responsible for the transportation of the sample; Asper Biogene is not responsible for incidents that may happen with the sample during the transportation (losing the sample, breaking the package of the sample, delivering the sample to a wrong address); and that

- the results of the test shall be sent only to the e-mail address(es) markedabove in 5 working days since the sample has reached Asper Biogene, if not otherwise agreed; and that

- the results of the test are my personal property and I am entitled to handle them at my discretion. Asper Biogene confirms that it does not disclose personal data of the tested individuals and the results of the test to any third persons; and that

- testing shall be performed according to good laboratory practice and international quality requirements. The performance of the test shall be based on the molecular biological data available for Asper Biogene at the present moment.; and that

- Asper Biogene does not forward genetic material of the tested individuals to any third persons or does not perform other genetic research by using genetic material of the tested individuals; and that

- the test results are not legally defensible in court due to uncertainty of the provided samples; and that

- I have ordered the testing under my responsibility and I shall personally bear all the incidental consequences. Asper Biogene is not responsible for any material, moral, social or psychological consequences, which may be caused by the result of the test. I have a right to renounce the knowledge of the results of the test by informing Asper Biogene about my decision in writing before the results have been issued, whereas it does not give me the right to reclaim the sum paid for the test if the testing has been completed.

I herebygive my consent** to Asper Biogene (registry code 14265334), address Vaksali 17a, Tartu, Estonia, e-mail: ) to identify the biological relationship between the individuals marked in the table above.

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NameSignatureDate

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NameSignatureDate

** If the child is under 18 of age, the form must be signed by both parents or legal guardians.

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ASPER BIOGENE LLC • reg nr 14265334 • Vaksali 17A, 50410 Tartu, Estonia

tel +372 7307 295 • fax +372 7307 298 • •