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Company Name *

Contact Person *

Email ID

Location *

Product Details

Bottle Type

HDPE bottle

Multilayer bottle

Translucent bottle

Closure Type

CT Closure

CR Closure (Desiccant/ Non desiccant)

Component's Description

Regulatory Requirements

US - DMF

Canadian DMF

EU Compliance

Others Specify

Raw Material Details

Resin Generic Name

Resin Brand Name

Resin Supplier

Details of Colorant / Master Batch: (As and where applicable)

Master Batch Grade /Source

Colorant % addition

Liner Details, if Require

Annual Requirement

Sample of concept or Innovator/Reference samples/Drawings / specification Or Photo in attachment

If any Special Requirement

Patent nos., if applicable

Filled by (Name)

Sing. / Date