Purchase of Scheduled Category 2 substances only
Order Reference:
Order Date:
Substance requested:
A separate declaration is required for each scheduled substance
Description should include
quantity, amount in gm and
combined nomenclature
code
Customer Declaration of specific uses of the Schedule category 2 substance
described above (individual transactions)
Our annual usage is below the threshold quantities specified in the regulations and therefore no
registration is required
I/We
Name………………………………………………………………………………………………………………………………………
Address……………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
Have ordered from:
Name
…………………………………………………………………………………………………………………………………………………
Address……………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
These substances will be used for:
………………………………………………………………………………………………………………………………………………
I/We hereby certify that the substances referred to above will not be resold or otherwise
supplied to any person outside the School of Life Sciences.
Signature:………………………………………………………………………………………………………………………………
Name:……………………………………………………………………………………………………………………………………
(in block capitals)
Position…………………………………………………………………………………………………………………………………
Date:……………………………………………………………………………………………………………………………………