Report of Insecticides Analyst _________________ Sl.No.__________
1. Name of the Insecticides Inspector, from whom samples
2. Serial No. and date of Insecticides Inspector's memorandum.__________
3. Number of the sample._____________________________________
4. Date of receipt.__________________________________________
5. Name of the insecticides purporting to be continued
in the sample .
6. Condition of the seals on the package; state whether :-
i. The sample was properly sealed and fastened
ii. The seal was intact and unbroken.
The seal fixed on the container and the outer cover of the sample
iv. The sample was in a condition fit for analysis.
7. Date of the test or
I certify that I have analyzed / caused to be analyzed the aforementioned sample, and declare the result of analysis to be as above.
(signature with seal)