FORM II
(To be submitted in duplicate)
[See paragraphs 2 and 5]

Form of information in respect of price of non-Scheduled bulk drugs.

1. Name of the bulk drug

2. Name of the manufacturer

3. Address of the Registered/Head Office of the Manufacturer

4. Address of the Factory

5. Capacity under Industrial License/Small Scale Industry Registration / Industrial Entrepreneur Memorandum acknowledgement

(a) Number and date of Industrial License/Small Scale Industry Registration/ Industrial Entrepreneur Memorandum acknowledgement

(b) Production Capacity (Tones/Kgs./Litres etc.)

6. Annual Installed Capacity

7. Date of commencement of commercial production

8. Actual production achieved during the last accounting year/current year (Tones/Kgs./Litres etc.)

9. Brief note on the manufacturing process

10. Estimated production of the bulk drug for next three years

11. If the production is proposed to be captively consumed for manufacture of formulation, please furnish the quantity to be so consumed out of the production given against SL.no.8 and 10

12. Please furnish latest c.i.f. price of the bulk drug if the same had been imported or is being imported by you or any agency known to you

13. Please furnish the cost of production of the bulk drug as under:-

I. Name of the Bulk Drug
II.Period
III.Major Raw Materials:- Name:
IV.Quantity consumed per kg. of Product:
V.Total Raw Material Cost
VI.Cost of production
VII.Cost of Sales
VIII.Profit Margin
IX.Selling Price (VI+VII)
X.Existing price with effective date

14. Please furnish a copy each of the audited Balance Sheet, Profit and Loss Account for the last three years and the latest Cost Audit Report and Annual Report

NOTE: THE INFORMATION FURNISHED IN THIS FORM IS TO BE CERTIFIED BY THE AUTHORISED SIGNATORY OF THE COMPANY AND BY THE COST ACCOUNTANT/ CHARTERED ACCOUNTANT.

The information furnished above is correct and true to the best of my knowledge and belief.

                     Authorised Signatory:

Place:            Name:
Date:             Designation:

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