FEROZSONS LABORATORIES LIMITED

QC REPORT REFERENCE NO: ________________.

NEW MANUFACTURER / MATERIAL
EVALUATION & APPROVAL FORM FOR PRODUCTION TRIAL
NEW MANUFACTURER  NEW MATERIAL 
Excipient  API  Packing Material Primary  Packing Material Secondary  Other 

Name of Material (To be inducted):

Reason for Induction: New Product  Economical  Quality  Alternate Source development 

Manufacturer Name:

Address:

Local agent Name:

Local agent Address &

Contact:

Provide material for production trial purpose.

Quantity Available:
Request for Material Trial:
Quantity Required:

Remarks:

Batches Manufactured  Process difficulties YES  NO 

Batches Manufactured,
Packed: Batches Packed  Not Applicable 

Remarks:

Manager Production /
Product Development: Manager QA:
(Sign & date)
(Signature & date)

Batch Testing: Batch testing completed  Stability Meet Requirements  Not Applicable 

QC Report & Remarks:

Manager
Manager Quality Control Manager PD:
QA:
(Signature & date) (Sign & date)
(Sign & date)

Probation  General
Director QO:
Supplier Status: Approved  (Sign & date)
Manager:
(Sign & date)
Not Approved 
Remarks:

Note: Original completed Evaluation and Approval form will be retained by Procurement department.

Copy To: Plant Manager, DQO, MQA, PDM, W/H.M and PM.

Form No. FZ/137 Stage 2