CUSTOMER DECLARATION SHOWING THE USE(S) OF A CATEGORY 2 SUBSTANCE(INDIVIDUAL TRANSACTIONS)I/We,Name of company.................................................................................................................Address..................................................................................................................have ordered from:REAGENT CHEMICAL SERVICES LTDAddress 18 Aston Fields Road, WhitehouseInd Est, Runcorn, Cheshire WA7 3DL the following substance: POTASSIUM PERMANGANATE - CN Code - 2841 6000(quantity).................................................................................................................The substance will be used for...........................................................................................................................Signed.................................................................... Name......................................................................Position................................................................... Date........................................................................RCP19/2 (POTASSIUM PERMANGANATE)If you are not the end user of this product (for example, you may be selling this on to another party), you will also have to contact the Home Office – please see their website at http://drugs.homeoffice.gov.uk/ - who will issue you with a registration number to sell this product on.
Registration No or reference ..........................................................
Registered on .......................................(date) by.......................................................(name & address of authority)
Accreditation to ISO 9001:2000 for the manufacture and
supply of reagents
and standards.
100% technical
support before,
during and
after purchase.
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