PROFORMA FOR SUBMISSION OF SAMPLES FOR TOXICOLOGICAL ANALYSIS Ref. F.No. .............. Date: .................. Sample No. & Details: ..................................... Whether the case is legal or not: ............................... SL Particulars of Sample submitted Preservative Condition at the time of sending 1 2 3 4 Date & place of collection Animal/species details Age / Sex Health History of case / Surviving cases Post mortem findings (please mention in detail for all the organs) Any suspicious thing in the vicinity (pesticides, fertilizers, chemicals, poisonous vegetation, etc) Toxicant suspected for No. of animals affected No. of animal died In your opinion the death is malicious or natural: ..................... Toxicological Test desired: ....................................... Animal owner's comments:- Doctor's Comments :- (Signature) Name & Designation ----------------------------------------------------------------------------------------------------------------------------------------------------- For office use TAR F.No. : ........ dated: .......... Condition of sample: ..........................
