Silbase Scientific Services Pty Ltd

							     Silbase Scientific Services Pty Ltd

     APPLICATION FOR DNA TESTING FOR TWINS



I/we,...............................................................................…….......................................................
           (Surname)                                                           (Given name(s))



.…&................................................................................…….......................................................
           (Surname)                                                           (Given name(s))



of....................................................................................………..................................................
           (Address to which report should be sent)



…………………………………………………………………………………………………



Contact Phone number…..…………………………………………………………………

hereby make application to Silbase Scientific Services Pty Ltd for DNA genetic
tests to be performed on the following twins.



Twin 1: Name of child…………………………………………………………………………
                                             (Surname)                                    (Given name(s))



Twin 2: Name of child………………………………………………………………………..
                                             (Surname)                                    (Given name(s))



Twins date of birth:                                    …..…/..……/….…
                                             Day      Month Year



Sex of twins (please circle):                Male / Female



Signed ……...........................................                           Signed .................................…...........

Date       ............................….......……....                          Date       ….......…….....................................

Return Application Form to:
Silbase Scientific Services Pty Ltd
A.C.N. 080 724 027
PO Box 115
Fitzroy VIC 3065
Phone: 02 9983 0611 / 03 9417 2400
Fax:    02 9983 0943 / 03 9416 3808
E-mail: silbase@genetype.com.au
Website: www.silbase.com.au