DDB IDADIN Form 5-06 Republic of the Philippines

Name of Company Office of the President

Address DANGEROUS DRUGS BOARD
P-License Number 3/F, DDB-PDEA Bldg, NIA Northsite Road, National Government Center
Brgy Pinyahan, Quezon City

Summary of Approved Transactions on Controlled Precursors and Essential Chemicals/Mixtures

(To be submitted by importers/exporters/manufacturers/distributors of CPECs/ Mixtures)
For the period covering from _____________ to ____________

Name of CPECs / Beg. Quantity Received Total Name of Quantity Disposed Total End
CPECs Mixtures Balance Imported Locally Manufactured Others Quantity Supplier/ Exported Sold to Sold to Used Surrendered to Destroyed w/ prior Others Quantity Balance
& its purity/concentration* Purchased Received Country (Country of Distributors End-users for PDEA approval from (e.g. loss) Disposed
(A) (B) of Origin destination) manufacture of PDEA & witnessed (give details) (C) (A+B-C)
other preparations by PDEA Officers*

* purity is the percentage content of drug in the sample material.

concentration is the amount of a substance, express in mass or molar unit, in a unit volume of fluid.

CERTIFIED TRUE AND CORRECT:

Printed Name/Signature
of Authorized Company Officer