WMA - Weighing Instrument Verification Rejection Notice

Weighing Instrument Verification Rejection Notice

Weights & Measures Act - Official Record of Rejection

Notice & Application Reference

Notice No.:

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Application No.:

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Customer Information

Customer Name:

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TIN Number:

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Phone:

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Instrument Details

Instrument Type	{{ $instrumentType ?? '' }}	Verification Type	{{ $verificationType ?? '' }}
Manufacturer / Model	{{ $manufacturerModel ?? '' }}	Serial Number	{{ $serialNumber ?? '' }}
Verification Site	{{ $verificationSite ?? '' }}	Collection Center	{{ $collectionCenter ?? '' }}
Date Rejected	{{ $rejectedDate ?? '' }}

Reason for Rejection

Official Determination

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Verifying Inspector

Signature & Stamp

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Regional Manager

Weights and Measures Agency - Official Seal

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