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PDEA S Register 3-14 No.


(records required of a distributor)

Diazepam (Valium) 10mg Amp

IN OUT Initial Stock/Blance Forwarded 500

Date Received Supplier Information: Name, Address, PDEA Quantity Date Sold or S4/S3 License Local Permit Quantity Sold Balance
Name of Purchaser Address Name of Trucker/Carrier
License No., Local Permit No., Date Issued Received Delivered No. No. or Delivered

Zuellig Pharma Corporation Bo.


Pittland, City of Cabuyao, Laguna, S4-
3/9/2018 000910007-R083, LOP003506-003508- 500 0 500
18, 2/28/2018

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