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Summary Report of Approved Transactions on Dangerous Drugs
PDEA summary of report form for approved transactions on dangerous drugs
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: DDB IDADIN Form 4-06
Name of Company
Address
S-License Number
Republic of the Philippines
Office of the President
DANGEROUS DRUGS BOARD
3/F, DDB-PDEA Bldg, NIA Northsite Road, National Government Center
Brgy Pinyahan, Quezon City
Summary Report of Approved Transactions on Dangerous Drugs/Preparations
(To be submitted by Importers/exporters/manufacturers and distributors of DD/preparations)
For the period covering from ___________ to ___________
Name of Dangerous
Drugs/Preparations
Beg.
Quantity Received
Balance Imported Locally Manufactured Others Total
(Country Purchased
(A)
of Origin)
(B)
Name of
Supplier
Quantity Disposed
Exported
Sold to
Sold to
Sold to
Sold to
Sold to
Used as Raw Surrendered to Destroyed w/ prior
Others
(Country of Distributors Gov't Hospitals Private Drugstores Physicians Materials for
PDEA
approval from
(e.g. loss)
destination)
Hospitals
manufacture of
PDEA & witnessed (give details)
or Clinics
DD preparations
by PDEA Officers*
Note: Fill-out all columns. Indicate n/a if not applicable & nothing follows.
CERTIFIED TRUE AND CORRECT:
Printed Name/Signature
of Company Authorized Pharmacist
Total
(C)
End
Balance
(A+B-C)
