FORM V
(See Paragraph 2,14 and 15)
Form of price List
- Name and address of the manufacturer/importer/distributor.
- Name and address of the marketing company, if any.
- Details of Prices:-
| Sl.No. |
Name of the Product (BulkDrug/Formulation and its dosage form) |
Composition approved by Drug Control Authorities |
Specifications of the pack |
| |
|
|
Type (*) |
Size (**) |
| 1 |
2 |
3 |
4 |
5 |
A.BULK DRUGS
1.
2.
3.etc.
B.FORMULATIONS
I. Own Production\
1.
2.
3. etc
II. Purchased
1.
2.
3.etc.
Excise Duty, If
any |
Local Tax, if any |
Price to be Retailed (inclusive) of excise(Duty) |
Retail Price (inclusive of excise ) (Duty) |
Maximum Retail Price incl. Of All Taxes |
Effective Batch Number and Date |
| Rate (Rs) |
Amt (Rs) |
Amt. (Rs.) |
Amount (Rs.) |
(Rs.) |
(Rs.) |
(Rs.) |
| 6 |
7 |
8 |
9 |
10 |
11 |
12 |
(*) Strip, Bottle etc.
(**) 10's, 100's, 1 ml, 1 gm etc.
NOTES:
- Information to be given separately for Scheduled and Non-Scheduled items.
- In case of purchased formulation, name of the manufacturer shall be indicated.
- The price list must be signed by the authorised signatory of the manufacturers, importer
or distributor.
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