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Herbarium Voucher Specimen and Crude Drug Analysis Requisition Form

(Please tick on the desired experiment) Date : …...…./…..……./…………

Name of Indenter & intercom No.………………….……………………………………. Project No.: ……………… Project Title:……………………………………………….. Department/Division: ……………………………..…………... A. Sample detail for Herbarium Botanical name of the Plant:………………………………………………

Vernacular Name:……………….……………………..…………….…..

Nature of the specimen (Fresh / Dry):………………….…………………

Source (Cultivated / wild):………………….……….……………………

Date of collection:………………….. Place of collection:………………..

No. of specimen: ………………………………………..……………….. (for herbarium, specimen should be in flowering stage) B. Sample detail for Crude drug Botanical name of the Plant:………………………….…………………..

Vernacular Name:……………….……………………………………….

Nature of the specimen (Fresh / Dry):……………………….……………

Drug part (leaf/stem/root/seed/ flower/ whole plant etc.):………………..

Source (Cultivated / wild / market sample):………………………………

Date of collection:………………… Place of collection:…………………

No. of samples: ……………………

Parameters: a) Crude Drug Repository Voucher specimen No. b) Detail analysis-

1) Macroscopic, 2) Microscopic, 3) Organoleptic, 4) Powder analysis,

5) Moisture content, 6) Foreign matter, 7) Ash value, 8) Acid insoluble ash,

9) Sulphated ash, 10) Extractive values (water / alcohol), 10) pH

11) others …………………………………………….

Project Coordinator / PI Signature of Indenter

BOTANY AND PHRMACOGNOSY CSIR-CIMAP (CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow-226015)