FORM XXI
MEMORANDUM TO GOVERNMENT ANALYST

[Rule 34]

From

To

       The Government Analyst

The portion of samples / container described below is sent herewith for test or analysis under rule 34 of the Insecticides Rules, 1971. The portion of samples / container has been marked by me with the following mark :

Details of portion of sample or container with name of insecticide which it purports to contain.

Date :                                                                                          Insecticides Inspector
                                                                                                                          (Seal)