1. Section-A

Date		Name of Material
Batch Number		Quantity
Q.C. Number		Supplier Name
Mfg. Date		Exp. Date
Fill this form after reading carefully

Supplier categories:

Raw Material _____ Packing material ______ General Items ______Services ____

2. Section-B

Information to be provided by Supplier

2.1 Do you have Quality Management or QA systems? Yes No N/A

2.2 Do you perform inspection and verification at?

2.2.1 Distribution Stage Yes No N/A

2.2.2 Retail stage Yes No N/A

2.3 Is there any qualified personnel who can understand material or services specifications? Yes No N/A

2.4 Do you have a customer complaint system? Yes No N/A

2.5 Have you supplied any material/services to any Pharmaceutical Company? Yes No N/A

2.6 Have you supplied any material/services to Norwich Pharmaceuticals ever before? Yes No N/A

2.7 Do you have sufficient storage capacity to maintain inventory level for timely supply of goods? Yes No N/A

2.8 Do you have qualified/trained personnel for handling/storage/ preservation of materials? Yes No N/A

3. Section C (Only for internal purpose)

Company Data

3.1 For how long has the supplier been providing goods & services to the company?

________________________________________________________________

3.2 Has the supplier regularly met his commitment to the company with respect to:

3.2.1 Quality requirements Yes No N/A

3.2.2 On time delivery Yes No N/A

3.2.3 Other services like transportation Yes No N/A

3.3 Is the supplier financially sound to provide credit to the company? Yes No N/A

3.4 Does the supplier respond and supplies irregular purchase orders? Yes No N/A

3.5 Does the supplier enjoy good market reputation? Yes No N/A

4. Section D (To be completed by Quality Assurance)

On site Audit

Is this supplier quality conscious? Yes No N/A

Audit conducted by:

Approval From Quality Control Department:
Remarks:


Name:	Designation	Signature	Date:

Approval From Quality Assurance Department :
Remarks:


Name:	Designation	Signature	Date:

Approval From Production Department:
Remarks:


Name:	Designation	Signature	Date:

Audit Report:

Satisfactory _____________ Un-satisfactory ____________

5. Section D (To be completed by Quality Control Department)

5.1 Does samples provided from three consecutive batches Yes No N/A

5.2 Q.C analytical Report of Samples Passed Failed

6. Section E (To be completed by QA & Purchase Department)

Decision

6.1 Is the supplier/importer/other capable to fulfill our needs well in time? Yes No N/A

6.2 Is the supplier/importer/other supplies any material /services before? Yes No N/A

Reviewed By Purchase Committee:

Satisfactory _________ Un-satisfactory __________

Approved __________ Not Approved ____________

Remarks: ______________________________________________________________________________________________________________________________________________________________________________

Prepared By (Name): ________________________ Date ___________

(Procurement Manager)