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)