UNIVERSAL FORMULATONS PVT.

LTD
Chilhiya-2, Rupandehi, Nepal ,Tel. 071-621319

MATERIAL RECEIVING STATUS RECORD SHEET

Date:

MATERIAL NAME: _____________________________________ Reviewed By:

MATERIAL CODE:_________
BATCH NO.: ____________________
MFG Date: __________ EXP Date :____________ --------------------------
Received Quantity:
MANUFACTURER:
Certificate of Analysis
SUPPLIER :

TYPE OF CONTAINER: Available Not

NUMBER OF Drum Plastic Shipper Available
CONTAINERS: Bag Box
Product Description (Complies): Yes No
Leakage / Pilferage / ……………… Yes No
R/I No.:
SAMPLING DETAILS:
Date : Location:
Sampled container : Glass bottle / plastic bag / ………………….
Sampled Qty.: …………………………g / ml
Taken from container No.: ………………………
Storage requirement (If any) : ……………………
Sampling tool : Rod / spatula / scoop / ……………….
Sampling method : Normal / aseptic / …………………
Sampling procedure : SOP No.: SOP/QA/GE/021/03

Remarks: - :………………………………………………………………………….

Sampled By:
Signature/Date :