TO BE PRINTED ON CUSTOMER’S COMPANY LATTERHEAD (Please delete this line before print)

POISON SIGNED ORDER

To From

Matrioux (M) Sdn Bhd AIMST UniversityB-1-36, Kompleks Suria Kinrara, Department of BiotechnologyPersiaran Kinrara Seksyen 3, Jalan SemelingTaman Kinrara, 08100 Bedong47100 Puchong. Selangor DE. Kedah Darul AmanTel: 03-8080 2070Fax: 03-8075 2070

PO Number: PO00000356PO Date: 26/12/2014

Please supply the followings:

No. Product Code Product Name Pack Size Quantity

Purpose of which required

1 BLN#BIO-38032

TRIsure 100ml 100ml 1.00

2

3

4

5

6

7

8

IMPORTANTThis Original Poison Signed Order MUST BE SENT to Matrioux (M) Sdn Bhdwithin 7 days with complete details of Purpose of Purchase, officialCompany Stamp and Signature with Purchaser’s Name.

Any purchaser who fails or neglect to forward to the seller ___________________________________________________a written order duly signed by him shall be guilty of an Company’s Stamp and Signature of Chemical User/Purchaseroffence against the Poison Act 1952. Name: