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UF/TEC/016A DNA Testing Unistel Medical Laboratories Pty Ltd Suite 13 Private Bag X22 Tygervalley 7536 CANNOT BE USED FOR LEGAL PURPOSES R550 per sample X number of samples R Total Reference Nr Name and Surname Sample 1 ID Nr SURNAME FIRST NAME Identification Nr Lab Nr Postal address for results Bank Details. BANK Standard Bank Account Nr 041925858 Tel Nr. Branch Code 050410 Cheque Account Fax. Reference Name and Surname WE UNDERSTAND AND ACCEPT THAT All information is confidential* Forensic and/or Blood samples were collected for DNA evaluation and correctly labelled* All information is accepted at face value. The request form has been completed correctly. No responsibility is accepted for any ramifications that may occur as a result of the report and/or any losses that may occur as a result of human or technical error. Should gross negligence be proven the claim shall not exceed the value of the contract. Signed at Date Signature Specimen Type Marshal Casette Deliverd by Other Swab Specimen Receipt at Unistel Guthrie Card Hair Blood Received by Time received Date received d m y. BANK Standard Bank Account Nr 041925858 Tel Nr. Branch Code 050410 Cheque Account Fax. Reference Name and Surname WE UNDERSTAND AND ACCEPT THAT All information is confidential* Forensic and/or Blood samples were collected for DNA evaluation and correctly labelled* All information is accepted at face value. The request form has been completed correctly. No responsibility is accepted for any ramifications that may occur as a result of the report and/or any losses that may occur as a result of human or technical error. The request form has been completed correctly. No responsibility is accepted for any ramifications that may occur as a result of the report and/or any losses that may occur as a result of human or technical error. Should gross negligence be proven the claim shall not exceed the value of the contract. Signed at Date Signature Specimen Type Marshal Casette Deliverd by Other Swab Specimen Receipt at Unistel Guthrie Card Hair Blood Received by Time received Date received d m y. BANK Standard Bank Account Nr 041925858 Tel Nr. Branch Code 050410 Cheque Account Fax. Reference Name and Surname WE UNDERSTAND AND ACCEPT THAT All information is confidential* Forensic and/or Blood samples were collected for DNA evaluation and correctly labelled* All information is accepted at face value. The request form has been completed correctly. No responsibility is accepted for any ramifications that may occur as a result of the report and/or any losses that may occur as a result of human or technical error. Should gross negligence be proven the claim shall not exceed the value of the contract. Signed at Date Signature Specimen Type Marshal Casette Deliverd by Other Swab Specimen Receipt at Unistel Guthrie Card Hair Blood Received by Time received Date received d m y.