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FORM V (See paragraphs 2, 14 and 15) Form of Price List 1. Name and address of the manufacturer/ importer/ distributor. 2. Name and address of the marketing company, if any. 3. Details of Prices :- Sl. No. Name of the Product (Bulk Drug/ Formulation and its dosage form) Composition approved by Drug Control Authorities Specifications of the pack Type (*) Size (**) 1. 2. 3. 4. 5. A. BULK DRUGS    1.    2.    3. etc B. FORMULATIONS I. Own Production    1.    2.    3. etc II. Purchased    1.    2.    3. 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
Excise Duty, if any Local Tax, if any Price to be Retailed (inclusive of Excise Duty) (Rs.) Retail Price (inclusive of Excise Duty) (Rs.) Maximum Retail Price inclusive of All Taxes (Rs.) Effective Batch Number and Date Rate (Rs.) Amount (Rs.) Amount (Rs.) 6. 7. 8. 9. 10. 11. 12.
(*) Strip, Bottle etc. (**) 10's, 100's, 1 ml, 1 gm etc NOTES: Information to be given separately for Scheduled and Non-Scheduled Items. In case of purshased formulation, name of the manufacturer shall be indicated. The price list must be signed by the authorised signatory of the manufacturers, importer or distributor