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 PO quantity: Pieces PO completed. 350,000

Label

English Text Label, Vietnam, 3 ml, (LV3) LV3-12-01 KM_LFYS_VIET_3 24 May 2012 31 May 2012 31 May 2012 Check with validated specifications PPM/12LV3 Detailed check list attached to this document. Complies with Specification. Approved.

LV3/09/12
31 May 2012 350,000 Pieces (7 Packets x 5 Rolls x 10,000 Pieces) DO quantity for this delivery: 350,000 Pieces Remaining balance after this delivery: NIL

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, May 31, 2012

Checked By (Signature): Name: William Chandra Designation: Designation: Department: Department: Date: Thursday, May 31, 2012

Retention Sample taken from Packet = 30 pieces from 3 rolls

Description of Item received Copy of this document Quantity (Pieces) 1 Received By (Signature) Received By Packaging Section Head PS Head
Edition: 6

Date 31 May 2012 31 May

Approved status labels 7

Ref. SOP. NO. 107.8

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 starting materials

Label
Storekeeper PS Head Storekeeper 2012 31 May 2012

350,000

Number of Approved labels printed: 8. Identical copy of Approved label is attached to this document.

Ref. SOP. NO. 107.8

Edition: 6

Date Effective: 01 June 2011