CHER 1 Boas) 3K (Medicine ) ii A 8 42 EF (mpor Report of Me (To Minister of Health, Labour and Welfare) Me OF th KORE BR Name of Importer __Mr. SUBRAMANIAN SENTHIL KUMAR Importer’s Signature CD + ‘Address of the Importer Noi BS, CREATION AISWARYAM APTS, 15% STREET, KUBERAN NAGAR EXTN, Address of Importer MADIPAKKAM, CHENNAI, TAMIL NADU INDIA Postal Coe : 600 091, Phone Number ST 29080 $2800, Fax Number e-mail senthilkumars@outlook.com Ji (Name and Size of the Import Products) Bi Aik _(Quantiy) () Tablets CETZINE 10 mg () 150 tablets in 15 strips tacts |@rorrenonal vse (Purpose of Import) | @ Other Purpose ( ) ‘ig #5 ae mq | @ The import products above are solely for the purpose of import above, not for oa commorcial use and/or gift for others. Nit Fa Rw oO i_(Name of Manvfucture and Country of Origin) () Tablets CHTZINE 10 mg - M/s Glaxo SmithKline Pharmaceuticals Ltd -INDIA. MARA A AWB, BIL 08 5: SUAS, SATE RRL GoetDate AD) | sy a Noorrghenny | __(t AS( Mior poor Saas i) 2017/ Jan / 02 SriLankan ‘ « i Wear) (Month) Dated Airlines (UL) 454 Narita International Airport Wi | (so) 4% FE | (For Omit Use) een & a moe FEA: i HIEALIE ty 4 ean, @ #