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DNA Test

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1836/F.S.L.-Iteam No. 7-H.G.P., Knl.

Annexure- III

Forensic Scince Laboratory, haryana, MADHUBAN-KARNAL

(An ISO/IEC 17025 Accredited Laboratory)

identification authentication form

1. Name
Occupation
2. Visible Identification Mark
3. Father's / Guaridian's / Husband's Name
4. Age
5. In case of Missing Identity
(Relation with the deceased)
6. Gender (Tick appropriate)
7. Caste & Origin of state
8. Address
Pin
9. Visible Genetic Abnormality (if any)
10. Date of sample collection
11. Case FIR no./PMR/MLR no. & date
12. Honorable court/ Police Station

Declaration by donor/Guaridian

[
Son/daughter/;Wife/under guaridian of
here by declare that the blood/smaple is given with my concent to FSL, Haryana , for DNA fingerprinting. Thge blood is mine/is of my child and I /Child did not recieve a blood transfusion/ bone marrow transplant within last three months.
(Thumb impression of the donor Signature Donor/Guaridian
ml of blood sample is collected in the presnces of the following witness.

Witness 1

1. Name
2. Signature
3. Address

Witness 2

1. Name
2. Signature
3. Address
The content of this form was readand explained to the donor/party in the language which the donor/ perty understands and thus fully understood the content of it.

Sample colected by:

Name
Signature
Date
Time
Address

Investigating officer/representative:

Name, Number & Rank
Signature
Date
Time
Note: Case FIR no. PMR/MLR no. and deatils of the donor should be learly mentioned on the EDTA vials, the vial should be sealed properly & the seal should be duly attested. The Sample should be transported immediately in thermos/ thermacol box stuffed with coolani pack or ice.
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