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)