ACCESS BUSINESS GROUP - TECHNICAL REGULATORY AFFAIRS
MATERIAL DATA REQUEST
ABG Use Only
Access Material #:
FARD #:
General Information
1.)Trade Name:
2.)U.S. INCI Name:
3.)Ten-digit Harmonized Tariff Schedule Export Classification Code Number:
4.) Physical Form of Material
5.) Is this material anano-particle (less than 100nmmean size in any dimension)?
6.) Does this material contain any heavy metals? NoYes If yes, quantify (ppm)
7.) Material Country of Origin:
8.) Is this material Kosher certified?
9.) Is this materialHalal certified?
10.) Surfactants Only: Identify Type (example-non-ionic):
Provide evidence of Biodegradability (example: EU Biodegradability Letter)
11.) Is this material bio-engineered? NoYes
If yes, identify the growth organism
If yes, identify the growth media
Required Documents
Please attach the following required documentation:
Material Composition Form
Specification or Technical Data Sheet
Material Safety Data Sheet ( Send both US and European version, if available)
Safety Support (Reports of toxicity studies, in vitro tests, HRIPT, etc. and other documents supporting safety)
BSE Certificate
Current Kosher/Halal Certificates (if applicable)
Botanical Ingredient Form Chart(if primary ingredients are plant derived)
Allergen Disclosure Form (Botanical Extract only)
.
Supplier Contact Information
Company:
Name:
Title:
Phone:
Fax:
E-mail:
Date:
ACCESS BUSINESS GROUP - TECHNICAL REGULATORY AFFAIRS
MATERIAL DATA REQUEST
ABG Use Only
Access Material #:
FARD #:
BSE Ingredient Certification
I hereby certify that the following material:
INCI Name:
Supplier Trade Name:
- IS NOT derived in whole or part from animal sources, and DOES NOT
utilize animal derivative(s) in its manufacture.
- IS derived in whole or part from animal sources, or DOES utilize
animal derivative(s) in its manufacture.
If derived from animal sources (item 2 above):
Raw Material Subcomponent Name(s)*
* List INCI names for all applicable animal-derived subcomponents of the raw material
Type of animal(s) and part(s) used**
** List animal(s) and part(s) used separately for each animal-derived subcomponent
Country of Origin of each Animal Type
Country of Slaughter of each Animal Type
Country(s) where Chemical Processing Occurs
Is this ingredient derived from tallow? (Check one): YES NO
If yes, is the tallow edible?
If yes, what method of processing is used? See listing to follow.
Transesterification or Hydrolysis at least 200 Degrees C at an appropriate corresponding pressure for 20 min.
Saponification with NaOH, 12M (Glycerol and Soap); Batch Process at 95 Degrees C for 3 hours
Saponification with continuous pressure at 140Degrees C, 2 bars (2000hPa) for 8 min or equivalent
If other, please provide details.
Company:
Name:
Title:
Date:
ACCESS BUSINESS GROUP - TECHNICAL REGULATORY AFFAIRS
MATERIAL DATA REQUEST
ABG Use Only
Access Material #:
FARD #:
Botanical Ingredient Form
Separate form must be completed for each botanical component
Trade Name:
INCI Name of Botanical Component :
Genus/Species:
Specify Plant Parts(check all that apply)
Root:
Stem:
Leaf:
Seed:
Twig:
Bark:
Other:
Feedstock Originand Processing
- Country of Origin.
- Is the Material extracted from the plant?
If yes, list solvents used in the extraction process including water.
`C. Provide a process flow chart for all botanical materials.
D. Is the Material Genetically Modified?
If yes, provide the detailed condition.
E. Is this material certified Organic? If yes, attach certification.
F. Was this plant material screened for pesticides?
If yes, what were the pesticides and their levels?
- Complete an Allergen Disclosure Form detailing any allergens as sited
in the IFRA Annex 1 to IFRA Standards of May 2007. (Required)
Company:
Date:
ABG
Access Material #:
FARD #:
MATERIAL COMPOSITION FORM
ALL FIELDS MUST BE COMPLETED. IDENTIFY ALL COMPONENTS
INCLUDING: preservatives, solvents, denaturants, contaminants, products and residuals.
Trade Name:
Company:
Date:
INCI NAME / CAS No. / Range% / Target
% / Source
Animal
Plant
Synthetic
Mineral
Bio-tech Petroleum / Country
Of
Origin / FUNCTION OF INGREDIENT
Intended Use
Surfactant
Emollient
Preservative / U Unintended Use
By-Product
Co Contaminant
Impurity
Residual
*CLS/JCIC/JSCI Number
(if applicable)
CLS= Comprehensive Licensing System (for Japan)
JCIC= Japanese Cosmetics Ingredient Codex
JSCI= Japanese Standards of Cosmetic Ingredients