FORM Doc No : FRM-QAS-034

QUALITY DISPOSITION Rev No : 01

Date : 11 Jan 2017
Page : 1

Fulfill by Initiator
No: Document :
Date: Initiator:
Detail Affected Material/Product (use additional row if necessary):
Item Num Item Name Lot Num Exp Date Qty UOM

Date :

(______________________)
Title:

Fulfill by QA
Decision

Release Rework Others………………………………

Release with exception Reject

Approved by Comment
Date :

(______________________)
Title:
Fulfill by Top Management (optional )
Disposition

Dispose Note:
Other : __________________________

Approved by Approved by
Date : Date :

(______________________) (______________________)
Title: Title:
Comment (use additional row if necessary):

Copy to : QA Logistic Supply Technical Finance 3PL WH Co-Mfg

 FORM Doc No : FRM-QAS-034
QUALITY DISPOSITION Rev No : 01
Date : 11 Jan 2017
Page : 1