General Screen Questionnaire

First and Last Name:

Tel Number:

Email:

Material Description

Material: Other:

Bulk Density: (t/m3)

Moisture: (Total and Surface)

Material Temperature: °C

Material is:

Other Characteristics: Other:

Application Requirements

Desired throughput rate (tph):

Maximum Particle size: mm X mm X mm

Desired Product size (State size and % passing):

How is material currently screened?

What improvements would you like to see?

How many cuts / screens and at what openings?

1 -

2 -

3 -

4 -

5 -

General Information

Project/Mine:

Location/Area:

Screen will:

Project is: about

Delivery is required by:

Personal Information Feedback: Shumar Engineering

Dear Business Partner

In terms of the Protection of Personal Information Act 4 of 2013, it is our duty to inform you of the categories of personal information collected from you in terms of your contractual agreements with Shumar Engineering. Shumar Engineering respects the right of privacy of our suppliers, vendors and contractors and we endeavour to ensure that your Personal Information is adequately protected, in accordance with the relevant data protection laws of our country.

As explained in the email and letter received, please complete the below questionnaire and submit.