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

Label

English Text Label, Thailand, 3 ml, (LT3)

LT3-12-01
KM_LFYS_THAI_3
06 March 2012
06 March 2012
06 March 2012
Check with validated specifications PPM/10LT3

7.2 Remarks 1

Detailed check list attached to this document.

Complies with Specification. Approved.

8. Laboratory QC No.
9. Date of Approval by QC
10. Total Quantity Approved

LT3/02/12

PO quantity:
Pieces
PO completed.

DO quantity for this delivery:

350,000 Pieces
Remaining balance after this delivery:

350,000

06 March 2012
350,000 Pieces
(7 Packets x 5 Rolls x 10,000 Pieces)

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.

Checked By (Signature):

Approved by (Signature):

Name:
William Chandra
Designation:
Designation:
Department:
Department:
Date:
Tuesday, March 06, 2012

Name:
Quality
Quality
Quality
Quality
Date:

Lee Yean Chin

Control Technician
Control Assistant Chemist
Control Department
Control Department
Tuesday, March 06, 2012

Retention Sample taken from Packet = 20 pieces from 2 rolls

Description of Item
received
Copy of this document

Ref. SOP. NO. 107.8

Quantit
y
(Pieces
)
1

Received By
(Signature)

Edition: 6

Received By

Date

Packaging Section

06 Mar

Head

2012
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)

Label

Approved status labels

PS Head

06 Mar

Approved starting

350,00

Storekeeper
PS Head

2012
06 Mar

materials

Storekeeper

2012

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