STATEMENT OF INDIVIDUAL DELIVERIES

NAME OF FARMER'S GROUP

DESIGNATED BUYING STATION
DATE OF DELIVERY

NAME OF FARMER/ MEMBER

DATE : __________

:
:

QTY. IN
BAGS OF
50 KG

VARIETY

GROSS WT. EFFECTIVE

(KG)
QTY. DEL. SIGNATURE REMARKS
AT COL. STAT
(G. KG)

TO BE ACCOMPLISHED BY THE WAREHOUSE SUPERVISOR

REFERENCE WSR NO. _______________________DELIVERY: ________________ VARIANCE : _______________(KGS)

ACTUAL TOTAL RECEIVED (KG) : ________________________

AT BUYING STATION

% VARIANCE : ____________________________

CERTIFIED CORRECT :

CONFORME :

__________________________________

______________________________

WAREHOUSE SUPERVISOR
DATE OF DELIVERY : ____________________________

FARMER'S GROUP COORDINATOR