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Customer Enquiry Form 1B
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  Please Indicate N.A. (Not applicable) in those sections that are not relevant.
  Please attach additional pages if necessary (more information or insufficient space provided)
  SECTION 1: COMPANY PARTICULARS
Name of Company (in block letters)
Address:
Tel No: Fax No: Email:

  SECTION 2:  CONTACT PERSON PARTICULARS
Name (Mr/Ms/Mrs/Mdm/Dr):
Designation:
Tel No: Fax No: Email:

  SECTION 3:  PRODUCT RELATED DETAILS (Please tick appropriate):
3.1 Brand Name/Strength
3.2 Benchmark (if applicable)
3.3 Product Sample Supply by Product Owner Supply by Beacons
3.4 Active Ingredients
3.5 Product Description
a) Product Classification CPM Medicinal Products Others
Others please specify:
b) Dosage Form Tablet Capsule Cream Gels Liquids Others
Others please specify:
c) Size/Shape
d) Colour
e) Flavour
f) Coating
g) Logo/Scoreline
h) Extra Specifications
3.6 Formula To be provided by: Product Owner Beacons

If provided by product owner, please furnish the details.

3.7 Manufacturing Process To be provided by: Product Owner Beacons

If provided by product owner, please furnish the details.

Process validation status: ( Yes / No)

3.8  Packaging a) Type/Material:
b) Pack Size:
3.9 Any special requirement needed a) Environment :
b) Equipment :
c) Others if any :
3.10 QC Testing Requirement Raw materials
Pharmacoepial Method
If selected, proceed to A.
Non-Pharmacoepial Method 
If selected, proceed to B.
A. USP       BP/EP       JP    

B. Validation Requirements if Non-Pharmacoepial Method is selected:

Finished products
Pharmacoepial
If selected, proceed to A.
Non-Pharmacoepial 
If selected, proceed to B.
A. USP       BP/EP     JP    

B. Validation Requirements if Non-Pharmacoepial Method is selected:

Additional Testing Requirement
Elaborate if there are any special requirement needed for testing in addition to the above mentioned:
Stability
Real Time OR Accelerated Real Time AND Accelerated
Temperature & Humidity Conditions:
Period of Study/Time Points:

  SECTION 4:  RAW MATERIALS SUPPLY (Please tick appropriate):
4.1 Active Ingredients   To be provided by: Product Owner  Beacons
4.2 Excipients To be provided by: Product Owner  Beacons
4.3 Packaging/Printing To be provided by: Product Owner  Beacons

  SECTION 5:  RECOMMENDATION (for Beacons use only):
5.1 Sales
5.2 Technical

  SECTION 6:  ESTIMATED COST (for Beacons use only):
6.1 Finance