EXPIRED MATERIAL SUPPLIER EVALUATION FORMEXPIRED MATERIALS SUPPLIER

566633428.DOCX
EVALUATION FORM

Version:  19/01/2018 Page: 1/3

1. GENERAL INFORMATION (filled by PVM Quality Department)

5Date: 24 06 2021
Requested by (name & job tittle): Pham Duc Thien

PVM Production Location:

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SUPPLIER DETAILS:

Name of Supplier: __ ________________________________________

Supplier contact person:__ _____________________________________

Address of manufacturing location: _____________________________________________________________

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MATERIAL DETAILS:

Material type: 312980 TF External Cofitos Coffee CAM/MAM

Product and batch ID: 04.04.2020
Expiry date: 04.04.2021

20Volume/Amount of product expired:        2,952.798

2. MATERIAL EVALUATION (filled by Supplier)

Evaluation date: ________________________________________________________________________________________________
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Evaluation done by: _____________________________________________________________________________________________

DESCRIPTION OF MATERIAL EVALUATION:

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Verify by Group Pack Dir, CMO Approved C R&D O

Classification: Internal
 EXPIRED MATERIAL SUPPLIER EVALUATION FORMEXPIRED MATERIALS SUPPLIER
566633428.DOCX
EVALUATION FORM

Version:  19/01/2018 Page: 2/3

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3. CONCLUSION (filled by Supplier)

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Verify by Group Pack Dir, CMO Approved C R&D O

Classification: Internal
 EXPIRED MATERIAL SUPPLIER EVALUATION FORMEXPIRED MATERIALS SUPPLIER
566633428.DOCX
EVALUATION FORM

Version:  19/01/2018 Page: 3/3

☐ The shelf life of the material can be extended without any health and safety risks
☐ Shelf life for the material may be extended to (dd/mm/yy): _________________________________
☐ It is not recommended to extend the shelf life of the material

Required storage conditions for the material:

Temperature (°C): ______________________________________________________________________________

Humidity (%RH): ________________________________________________________________________________

Other specific requirements or concerns:

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Potential Risks to consider for PVM linked to the extension of the shelf life of the material:
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Date: ______________________________________________________________________________

Name and job title, Supplier: _____________________________________________________________

Verify by Group Pack Dir, CMO Approved C R&D O

Classification: Internal