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Company Name:

Document No: Title: Issue No. Page No.

Deviation Proposal Form 1 Page 1 of 1

Department/Section: ____________________________________
Initiated By (Name) _____________________________________
Description of
Proposal:_____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________

Changed Parameters/Quantities
Old New
1
2
3
4
5
Reason For The
Proposal______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________________________
Signature of the Initiator__________________________________ Date _________________

Comment of Production Manager


_____________________________________________________________________

Comment of QA
Manager______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Sign________________

Comment of Plant
Manager______________________________________________________________________
_____________________________________________________Sign_____________

Confidential

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