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BORDEN CO. (PTE.) LTD.

Appendix 3

No. 9 Jalan Kilang, Singapore 159409 Form SMR.11T.L

Starting Materials Record (Status After Testing)


1. Name of starting material 2. Unit Identifying No. 3. Suppliers component No. 4. Date of goods received 5. Date of sampling 6. Date of QC checking 7.1 Checking details 7.2 Remarks 1 8. Laboratory QC No. 9. Date of approval by QC 10. Total quantity approved

Label

English Text Label, Vietnam, 12 ml, (LV1) LV1-12-01 KM_LFYS_VIET_12 27 March 2012 28 March 2012 29 March 2012 Check with validated specifications PPM/10LV1 Detailed check list attached to this document. Complies with Specification. Approved.

LV1/05/12
29 March 2012 55,000 Pieces (5 Rolls x 10,000 Pieces) + (1 Roll x 5,000 Pieces) DO quantity for this delivery: 55,000 Pieces Remaining balance after this delivery: NIL

PO quantity: Pieces PO completed.

55,000

Remarks 2: QC Approved. Approved Status Label provided to Packaging Section Head. Packaging Section Head is responsible to transfer the Approved status label to the Storekeeper and ask him to affix the Approved status labels on each packet. To transfer the goods to Approved Area and maintain the stock balance. Approved by (Signature): Name: Quality Quality Quality Quality Date: Lee Yean Chin Control Technician Control Assistant Chemist Control Department Control Department Thursday, March 29, 2012

Checked By (Signature): Name: William Chandra Designation: Designation: Department: Department: Date: Thursday, March 29, 2012

Retention Sample taken from Packet = 10 pieces from 1 roll


Description of Item received Copy of this document Quantity (Pieces) 1 Received By (Signature) Received By Packaging Section Date 29 Mar

Ref. SOP. NO. 107.8

Edition: 6

Date Effective: 01 June 2011

BORDEN CO. (PTE.) LTD.

Appendix 3

No. 9 Jalan Kilang, Singapore 159409 Form SMR.11T.L

Starting Materials Record (Status After Testing)


Approved status labels Approved starting materials

Label
Head PS Head Storekeeper PS Head Storekeeper 2012 29 Mar 2012 29 Mar 2012

1 55,000

Number of Approved labels printed: 2. Identical copy of Approved label is attached to this document.

Ref. SOP. NO. 107.8

Edition: 6

Date Effective: 01 June 2011

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