CERTIFICATION REQUEST
Name:
Title:
Mr
Mrs
Miss
Prof
Dr
Company:
Position:
Division:
Physical Address:
Postal Address:
E-Mail:
Mobile:
Office Telephone:
Fax:
Valve Type:
Gate
Globe
Swing Check
Dual Plate Check
Piston Check
Double Block & Bleed
Reducing
Change-over
Safety
Steam Trap
Butterfly
Strainer
Bottom Outlet
Sampling
Diverter
Ram
Piston
Plug
Valve Manufacturer:
Valve Figure Number:
Valve Size:
15 mm
20 mm
25 mm
32 mm
40 mm
50 mm
65 mm
80 mm
100 mm
125 mm
150 mm
200 mm
250 mm
300 mm
350 mm
400 mm
450 mm
500 mm
Valve Body Material:
Unknown
Cast Iron
Carbon Steel
Stainless steel
Chrome-moly
Ductile Iron
LCB
WC6
CF8C
CF8M
CF8
C5
C12
A105
LF2
Valve End Connections:
Screwed BSP
Screwed NP
T
Socket Weld
Buttweld
Flanged
Trim Material:
Standard
Unknown
Stainless Steel
NACE
13 Chrome
Half Stellite
Full Stellite
Monel
Elastomer
Not Applicable
Valve Configuration:
Standard
Handwheel
Gearbox
Actuated
Seal Configuration:
Unknown
Standard
Gland packing
Bellows
Valve Tag Number:
Valve Serial Number:
Valve Heat Numbers:
Date of Supply: