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Cell Line Identity Verification Sample Submission Form

This form should be faxed to the HPA Culture Collections prior to sending samples and the original must be included with the samples. In addition, a Biohazard Risk Assessment Form must be completed and submitted in order for your samples to be accepted. ECACC is required to assess the GMO and biohazard risk status of all deposits prior to receipt. Therefore, we will contact all depositors to advise them when we can receive samples.

DNA Fingerprinting, Isoenzyme Analysis and Multiplex PCR

 Name

 
 

 Job Title

 
 

 Company

 
 

 Address

   
 

 Postcode

 
 

 Country

 
 

 Telephone

 
 

 Fax

 
 

 Email

 
 

 Purchase Order Number

 
 Multilocus DNA - Fingerprinting / Multiplex PCR   Details of cell lines submitted:
1.

Cell Line Name

 
   
 

Suspected Species 

   
 

If frozen details of medium for growth

 

 Name and catalogue number of cell line to be compared to

   
   
2.

Cell Line Name

 
  
 

Suspected Species 

   
 

If frozen details of medium for growth

 
 

 Name and catalogue number of cell line to be compared to

 
   
3.

Cell Line Name

  
 
 

Suspected Species 

  
 

If frozen details of medium for growth

  
 

Name and catalogue number of cell line to be compared to

  

Isoenzyme   Details of cell lines submitted:

1.

 Cell Line Name

 
   

Suspected Species 

   

If frozen details of medium for growth

   
   
2.

Cell Line Name

  
   
 

Suspected Species 

  
 

If frozen details of medium for growth

  
   
3.

Cell Line Name

  
   
 

Suspected Species 

  
 

If frozen details of medium for growth