Sample Shipping Form for Sending Samples in Advance to Ul Japan

Issued: 2010/11/02

Revised: 2011/11/08

SAMPLE SHIPPING FORM FOR SENDING SAMPLES IN ADVANCE TO UL JAPAN

Note:

1. When you wish to send samples before the project planning, they should be sent to the address indicated below with a copy of this form provided inside each shipping container, and the information requested on this form MUST be included with the shipment. Incomplete, missing information, or shipment before quote may cause delay in handling your samples.

2. Additional samples might be requested if your submitted samples do not meet the items requested in the project planning.

For submittal of samples:

If time allows, it is advised to send your samples together with the formal “Sample Shipping Form” with ID number which will be sent to you from our Engineering department at the time of project planning instead of using this Preliminary Form.

Delivery Address: * If you are not sure of the addressee, please contact our contact person.

Only for UL Japan

The use of this form is restricted to UL Japan only.

Issued: 2010/11/02

Revised: 2011/11/08

Ise Office UL Japan Inc.

3600-18 Asama-cho, Ise-shi, Mie 516-0021 Japan

Attention: Sample Room Clerk

Tel: +81-596-24-7975

Tokyo Office UL Japan Inc.

Marunouchi Trust Tower

Main Building 6F, 1-8-3 Marunouchi,,
Chiyoda-ku, Tokyo 100-0005 Japan

Attention: Sample Room Clerk

Tel: +81-3-5293-6000

Only for UL Japan

The use of this form is restricted to UL Japan only.

Issued: 2010/11/02

Revised: 2011/11/08

COMPLETED BY CUSTOMER

Please fill in the following information.

Project# / Quote# : / * If you are not sure of the number, please contact our contact person.
UL Contact Person :
Reason for sending in advance : / （Optional）

Samples included with this shipment:

What would you like UL Japan to do with your sample(s) when work is complete? (Choose one)

Destroy * Samples that cannot be destroyed may be returned at your expense.
Customer to Pick Up at UL
Ship/Return at your expense
Insrance value for sample:
If sample is to be returned and you would like it billed to a specific shipper account, please indicate:
Shipper:
Account number:
Remarks
Sample Being Shipped to UL From: / UL Should Return Sample to (complete if sample to be returned and address different than at left):
* Please complete in Japanese if the delivery address is in Japan (not overseas).
Company Name: / Company Name:
Company Address: / Company Address:
Contact Depertment: / Contact Depertment:
Contact Person: / Contact Person:
Contact Phone: / Contact Phone:
Contact Email: / Contact Email:

Only for UL Japan

The use of this form is restricted to UL Japan only.