BORDEN CO. (PTE.) LTD.

No. 9 Jalan Kilang, Singapore 159409 Form SMR.11T.L

Appendix 3

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 English Text Label, Vietnam, 3 ml, (LV3) LV3-12-04 KM_LFYS_VIET_3 23 October 2012 23 October 2012 23 October 2012

Label

Check with validated specifications PPM/12LV3

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

LV3/27/12
23 October 2012 340,000 Pieces (6 Packets x 5 Rolls x 10,000 Pieces) + (1 Packet x 4 Rolls x 10,000 Pieces)

PO quantity: PO Completed.

340,000 Pieces

DO quantity for this delivery: 340,000 Pieces Remaining balance after this delivery: NIL

Remarks 2: QC Approved labels provided to Packaging Section Head. Inform the Packaging Section Head as follows: To provide Approved labels to the Storekeeper and instruct him to cancel the goods from Quarantine status. To affix Approved labels on each packet and transfer the goods to Approved Storage Area for packaging materials. To receive and record the total quantity of approved packaging materials.
Ref. SOP. NO. 107.8 Edition: 6 Date Effective: 01 June 2011

BORDEN CO. (PTE.) LTD.

No. 9 Jalan Kilang, Singapore 159409 Form SMR.11T.L

Appendix 3

Starting Materials Record (Status After Testing)

Label

Checked by (Signature): Name : Ng Xue Li Designation Chemist Department Department Date

Approved by (Signature): Name : : : : : William Chandra Quality Control Technician Quality Control Assistant Quality Control Department Quality Control Department : Tuesday, October 23, 2012

Designation

: Tuesday, October 23, 2012 Date

Retention sample taken from packet(s) = 20 Pieces from 2 Rolls

Description of item received Copy of this document

Quantity (Pieces) 1

Received by (Signature)

Received by Packaging Section Head

Date 23 Oct 2012 23 Oct 2012 23 Oct 2012

Approved status label(s) Approved starting materials

document.

PS Head Storekeeper

340,000

PS Head Storekeeper

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

Ref. SOP. NO. 107.8

Edition: 6

Date Effective: 01 June 2011