新化学品申购申请表
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Annual consumption/
Dept./部门：
Direct import/ 直接进口
Daily/time consumption/
Yes/是 □ No /否 □
年使用量 Signature/签名 2.Purchase information/采购信息 Request No.(If any): 采购申请号（如有）： Filled in by Supplier quilificiation purchaser/ review/供应商资质审核 采购填写 Signature/签名 3.SHE compliance confirmation/SHE法律确认
5.Chemical reception/化学品接收 Storage location/ 储存位置 Chemical label review/ 化学品标签审核 Signature/签名 6.Purchase approval/购买批准
SHE manager/
Max/Min/storage Vol. 最大/最小储存量
License provided/obtained before purchase the chemical/采购该化学品前需提供/获得如下
许可 Supplier/供应商方 □ Dangerous chemicals production license/ □Safety production license / 危险化学品生产许可证 产许可证 Filled in by SHE; confirmed by applicant, purchaser and SHE together/ SHE填写； 申请人、采 购、SHE共 同确认 □ Dangerous chemicals safety registration certificate/ 危险化学品安全登记证明 □ New chemicals registration certificate/ 新化学物质登记证 □ Extremely toxic chemicals business license/ 剧毒化学品经营许可证 Roche/罗氏 安全生
Yes, not belongs to Extremely Toxic Chemicals/
□
是，但非剧毒品
□
No, identified as dangerous chemical/ 否，但经危险性鉴定为危化 □
Filled in by SHE/ SHE填写
No, identified as non dangerous Yes, belongs to Extremely Toxic Chemicals/ chemical/ 是，且为剧毒品 □ 否，但经危险性鉴定为非危化 □ 3.If it exists in Key Environmental Management of Hazardous Chemicals Directory/ 是 否在《重点环境管理危险化学品目录》中 Yes/是 □ No/否 □ 4.If it exists in Precursor Chemicals Directory/是否在《易制毒化学品名录》中 Yes, Category I/ Yes, Category II/ Yes, Category III/ No/ 是，I类 □ □ 是，II类 □ 是，III类 □ 否 5.If it exists in Easy to Make Explosive Chemicals Directory / 是否在《易制爆危险化学品名录》中 Yes/是 □ No/否 □
Filled in by warehouse/ 仓库填写
Байду номын сангаас
SHE经理：
procurement Manager/
采购经理：
6.If it exists in China Strictly Limits the Import and Export of Toxic Chemicals Directory/是否在《中国严格限制进出口的有毒化学品目录》中 Yes/是 □ No/否 □ 7.If it exists in Pharmaceutical Precursor Chemicals Directory/ 是否在《药品类易制毒化学品名录》中 Yes/是 □ No/否 □ Signature/签名 4.Confirmation before purchase/购买前确认
□ Dangerous chemicals environment registration certificate/ 危险化学品环境登记证明 □ Precursor chemicals business license/易制毒化学品经营许可证 □ other/ 其他________________________
□ Dangerous chemicals safety registration certificate/ □ Dangerous chemicals environment registration certificate/ 危险化学品安全登记证明 危险化学品环境登记证明 □ New chemicals registration certificate/ □ Precursor chemicals purchase 新化学物质登记证 record/易制毒化学品购买备案 □ Extremely toxic chemicals purchase record/ □ Easy to make explosive chemicals purchase 剧毒化学品购买备案 record/ 易制爆化学品购买备案 □ other/其他_____________________________ Signature/签名
日/次使用量
SDS acquisition/ SDS获取
1.If it exists in China Existing Chemical Substances, including mixture components/ 是 否在《中国现有化学物质名录中》中，包括混合物各组份 Yes/是 □
No, defined as new chemical by Environmental Protection Ministry/
Purchase Application Form for New Chemical 新化学品购买申请表
1.Basic information of chemical/化学品基本信息 Applicant/申请人： Chemical name /拟购买化学品名 Filled in by applicant/ 申请人填写 Supplier/供应商 Purpose/用途
否，但经环保部确认为新物质
□
No, defined as non new chemical by Environmental Protection Ministry/
否，但经环保部确认非新物质 2.If it exists in Dangerous Chemicals Direcctory/是否在《危险化学品名录》中
Dept./部门：
Direct import/ 直接进口
Daily/time consumption/
Yes/是 □ No /否 □
年使用量 Signature/签名 2.Purchase information/采购信息 Request No.(If any): 采购申请号（如有）： Filled in by Supplier quilificiation purchaser/ review/供应商资质审核 采购填写 Signature/签名 3.SHE compliance confirmation/SHE法律确认
5.Chemical reception/化学品接收 Storage location/ 储存位置 Chemical label review/ 化学品标签审核 Signature/签名 6.Purchase approval/购买批准
SHE manager/
Max/Min/storage Vol. 最大/最小储存量
License provided/obtained before purchase the chemical/采购该化学品前需提供/获得如下
许可 Supplier/供应商方 □ Dangerous chemicals production license/ □Safety production license / 危险化学品生产许可证 产许可证 Filled in by SHE; confirmed by applicant, purchaser and SHE together/ SHE填写； 申请人、采 购、SHE共 同确认 □ Dangerous chemicals safety registration certificate/ 危险化学品安全登记证明 □ New chemicals registration certificate/ 新化学物质登记证 □ Extremely toxic chemicals business license/ 剧毒化学品经营许可证 Roche/罗氏 安全生
Yes, not belongs to Extremely Toxic Chemicals/
□
是，但非剧毒品
□
No, identified as dangerous chemical/ 否，但经危险性鉴定为危化 □
Filled in by SHE/ SHE填写
No, identified as non dangerous Yes, belongs to Extremely Toxic Chemicals/ chemical/ 是，且为剧毒品 □ 否，但经危险性鉴定为非危化 □ 3.If it exists in Key Environmental Management of Hazardous Chemicals Directory/ 是 否在《重点环境管理危险化学品目录》中 Yes/是 □ No/否 □ 4.If it exists in Precursor Chemicals Directory/是否在《易制毒化学品名录》中 Yes, Category I/ Yes, Category II/ Yes, Category III/ No/ 是，I类 □ □ 是，II类 □ 是，III类 □ 否 5.If it exists in Easy to Make Explosive Chemicals Directory / 是否在《易制爆危险化学品名录》中 Yes/是 □ No/否 □
Filled in by warehouse/ 仓库填写
Байду номын сангаас
SHE经理：
procurement Manager/
采购经理：
6.If it exists in China Strictly Limits the Import and Export of Toxic Chemicals Directory/是否在《中国严格限制进出口的有毒化学品目录》中 Yes/是 □ No/否 □ 7.If it exists in Pharmaceutical Precursor Chemicals Directory/ 是否在《药品类易制毒化学品名录》中 Yes/是 □ No/否 □ Signature/签名 4.Confirmation before purchase/购买前确认
□ Dangerous chemicals environment registration certificate/ 危险化学品环境登记证明 □ Precursor chemicals business license/易制毒化学品经营许可证 □ other/ 其他________________________
□ Dangerous chemicals safety registration certificate/ □ Dangerous chemicals environment registration certificate/ 危险化学品安全登记证明 危险化学品环境登记证明 □ New chemicals registration certificate/ □ Precursor chemicals purchase 新化学物质登记证 record/易制毒化学品购买备案 □ Extremely toxic chemicals purchase record/ □ Easy to make explosive chemicals purchase 剧毒化学品购买备案 record/ 易制爆化学品购买备案 □ other/其他_____________________________ Signature/签名
日/次使用量
SDS acquisition/ SDS获取
1.If it exists in China Existing Chemical Substances, including mixture components/ 是 否在《中国现有化学物质名录中》中，包括混合物各组份 Yes/是 □
No, defined as new chemical by Environmental Protection Ministry/
Purchase Application Form for New Chemical 新化学品购买申请表
1.Basic information of chemical/化学品基本信息 Applicant/申请人： Chemical name /拟购买化学品名 Filled in by applicant/ 申请人填写 Supplier/供应商 Purpose/用途
否，但经环保部确认为新物质
□
No, defined as non new chemical by Environmental Protection Ministry/
否，但经环保部确认非新物质 2.If it exists in Dangerous Chemicals Direcctory/是否在《危险化学品名录》中