CENTRAL INSTRUMENTATION FACILITY (CIF)
                                                    IISER BHOPAL (M.P.)
                                             REQUISITION FORM FOR NMR 
                                               (Project No. NMR/R&D/2011006)
                                                                                                Date:
                Name of the Researcher: ………………………………………………………………………………………………………………………….
                Organization/Institution: …………………………………………………………………………………………………………………………
                Contact address: ………………………………………………………………………………………………………………………………………
                ………………………………………………………………………………………………………………………………………………………………….
                E-mail ID (if electronic copy of the NMR data is requested): ……………………………………………………………………
                Details of samples submitted:
                   Sample Codea,b         Solventc             Data requestedd                Spectrometer
                                                                                             (400 / 500 MHz)
                a Please specify if these samples are hazardous (corrosive/explosive/radioactive, etc.). If so, specify the 
                appropriate handling instructions
                b                                                           
                 If you would prefer to mention structures of these compounds,please use backside of this sheet 
                c 
                If solvent is not provided, please specify the solubility in chloroform/methanol/acetone/D2O/DMSO.
                d 
                 1H, 13C, DEPT, 2D, water/solvent suppression, any other nuclei. 
                Any other instructions: …………………………………………………………………………………………………………………………….
                ………………………………………………………………………………………………………………………………………………………………….
                Details of payment: State Bank Collect 
                SBCollect Reference No.:                                   Date:           Amount:
                Sample submission: Send the samples to following address 
                In-Charge, NMR facility, Indian Institute of Science Education and Research (IISER) Bhopal, 
                Bhopal By-pass Road, Bhauri, Bhoapl-462 066, Madhya Pradesh, India