FORM II (To be submitted in duplicate) ( See Paragraphs 2 and 5 ) Form of information in respect of price of non-Scheduled bulk drugs. 1. Name of the bulk drug. 2. Name of the manufacturer. 3. Address of the Registered/Head Office of the Manufacturer. 4. Address of the Factory. 5. Capacity under Industrial Licence/Small Scale Industry Registration/Industrial Entrepreneure Memorandum acknowledgement; Number and date of Industrial Licence/Small Scale Industry Registration/Industrial Entrepreneure Memorandum acknowledgement; (b) Production Capacity (Tonnes/Kgs./Litres etc.).

• Definitions • Fixation of Sale Prices    of Bulk Drugs • Bulk Drug Manufacturers • Calculation of Retail Price • Power to fix Formulation Prices • Power to Fix Ceiling Price • Power to recover Dues • Power to recover Overcharged Amt. • Issue of Price List • Power to Review • List of Price Controlled Drugs • Application for Bulk    Drug prices : Form I • Information for non-Scheduled    Bulk Drugs : Form II • Application for Formulation    Prices : Form III • Form IV, V, VI • The Third Schedule

6. Annual Installed Capacity. 7. Date of commencement of commercial production. 8. Actual production achieved during the last accounting year/current year (Tonnes/Kgs./Litres etc.). 9. Brief note on the manufacturing process. 10. Estimated production of the bulk drug for next three years. 11. If the production is proposed to be captively consumed for manufacture of formulation, please furnish the quantity to be so consumed out of the production given against S1. NO. 8 and 10. 12. Please furnish latest c.i.f price of the bulk drug if the same had been imported or is being imported by you or any agency known to you. 13. Please furnish the cost of production of the bulk drug as under: - Name of the Bulk Drug. Period. Major Raw Materials :- Name; Quantity consumed per Kg. of Product; Cost per Kg. of Product; Total Raw Material Cost. Cost of production Cost of Sales Profit Margin Selling Price (VI+VII). Existing price with effective date 14. Please furnish a copy each of the audited Balance Sheet, Profit and Loss Account for the last three years and the latest Cost Audit Report and Annual Report. NOTE : The information furnished in this form is to be certified by the authorised signatory of the company and by the cost accountant/chartered accountant. The information furnished above is correct and true to the best of my knowledge and belief Authorised Signatory : Place : Name : Date : Designation :