DNA sequencing Requisition Form
Please read the instruction carefully during filling up the form. Please read the detailed information at http://nib.gov.bd/site/page/222a9260-0d18-4730-9589-8b258f9e2cf5/%E0%A6%A1%E0%A6%BF%E0%A6%8F%E0%A6%A8%E0%A6%8F-%E0%A6%B8%E0%A6%BF%E0%A6%95%E0%A7%8B%E0%A7%9F%E0%A7%87%E0%A6%A8%E0%A7%8D%E0%A6%B8%E0%A6%BF%E0%A6%82

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If you need further information please call us at E-mail: <keshob@nib.gov.bd>, <keshob@gmail.com> Phone (office): +88027788443; Mobile: +8801712687287

Email address *
Name
Designation and institutional affiliation *
Your institutional affiliation and postal address
Phone number *
Number of non-purified samples (2000 Tk/sample) *
Please enter the number of non-purified samples
Number of purified samples (1500 Tk/sample) *
Please enter the number of purified samples
Total Number of samples *
Please enter the total number of samples (non-purified + purified)
Paid amount *
Please write down the amount paid in Taka
Payment method *
Payment Reference *
Information on transaction reference, bank information, date, etc.
Detailed sample information
Please provide detailed information on your samples
Sample Identity, status, product size, and concentration *
Please provide sample identity, status (purified/non-purified), product size, DNA concentration and primer concentration separated by comma. Hit enter button to enter the next sample. Example: Seq 1, purified, 825bp, 25ng/ul, 5 pmole (and hit enter button to enter the next sample).
Gel images of the sample
Please name your gel image file as: image-1, image-2, image-3 etc. You can upload up to 10 image files at once.
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