Certificate of Free Sale Request Form

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1 Certificate of Free Sale Request Form E A Certificate of Free Sale is a formal affidavit attesting that the products being imported are of the same quality as those manufactured and sold freely in the U.S. PLEASE NOTE: This document cannot be used as a Certificate of Good Manufacturing Practice (GMP), nor can it be altered in any way from the original format or language. The two tier pricing model reflects the authentication requirements of the more than 140 countries ICMAD services. All shipping charges and certification costs are part of the fee. No additional invoice or shipping charges will apply. Approximate turnaround time is 2-4 business weeks, some countries up to 6 weeks. Please fill out the following information completely. Any missing information will delay the processing of your Certificate. -Company Name -Company requesting is: U.S. Manufacturer OR U.S. Distributor* Member Number **If you are a Member Distributor please include your Manufacturer s contact information on Page 2. Manufacturers or Distributors requesting application MUST be ICMAD members. The FDA s definition of a Manufacturer is the company actually filling the product. -Please provide the country name in the spaces below for the type of COFS. Refer to Pages 3 and 4 for country listings. Apostille normal $195 Authority $345 Apostille expedited $370 (7-10 days turnaround time) -Name and address of Member Company contact person to send completed certificate: -Contact address & phone number: Mail this form with your completed application and check or credit card authorization to: ICMAD, Addison Road, Suite 200, Addison, TX Please note: The application must be signed by an officer of the ICMAD member manufacturer/distributor and must be notarized (see Page 2). This document should serve as your official INVOICE. If you have questions, contact Megan Marquis ext. 109 ICMAD COFS Form 1

2 Certificate of Free Sale Application (Company name and address typed below will appear as is on the Certificate.) 1.) Name and address of U.S. based ICMAD Member Manufacturer: Company Address City, State, Zip Telephone: Fax: 2.) Name and address of U.S. based ICMAD Member Distributor (If Distributor is requesting COFS): Company Address City, State, Zip Telephone: Fax: 3) Please indicate which company should appear on the Certificate if U.S.Distributor is requesting. 4) Cosmetic(s) requiring Certificate: (Please include exact product name and attach list on letterhead if too large; also include type of cosmetic product i.e. lotion, toner, polish etc. for ICMAD s purposes only): 5) ICMAD Member Manufacturer/Distributor certifies that: a. it abides by all Federal and State regulations relating to the manufacturing and marketing of this product. b. its product and manufacturing methods comply with appropriate Good Manufacturing Practice guidelines. c. its products are currently sold freely throughout the United States and are the same products that it intends to export. Notarized By: Corporate Executive Signature (Requester) ICMAD COFS Form Title and Date 2

3 Apostille Countries - $195 normal fee (3 weeks) / $370 expedited (1-2 weeks) Albania Andorra Antigua & Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain* Barbados Belarus Belgium Belize Bosnia & Herzegovina Botswana Brazil** Brunei Darussalam Bulgaria Cape Verde Chile Colombia Cook Islands Costa Rica Croatia Cyprus Czech Republic Denmark Dominica Dominican Republic Ecuador El Salvador Estonia Fiji Finland France FYR of Macedonia Georgia Germany Greece Grenada Honduras Hong Kong Hungary Iceland India Ireland Israel Italy Japan Kazakhstan Kyrgyzstan Latvia Lesotho Liberia Lichtenstein Lithuania Luxembourg Malawi Malta Marshall Islands Mauritius Mexico Monaco Mongolia Montenegro Morocco Namibia Netherlands New Zealand Niue Nicaragua Norway Oman Panama Paraguay* Peru Poland Portugal Republic of Moldova Romania Russia* Optional Translation Yes or No (Add l fee required) Saint Kitts and Nevis Saint Lucia Saint Vincent & Grenadines Samoa San Marino Sao Tome & Principe Serbia Seychelles Slovakia Slovenia South Africa South Korea Spain Suriname Swaziland Sweden Switzerland Tonga Trinidad & Tobago Turkey Ukraine United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Yugoslavia *Special Notes for Apostille Countries: Brazil: requires an electronic version of the product list as it must be copied and pasted into the body of the GMP Certificate. Please the product list as a Word or Excel document. Russia: translation is now optional. Please mark on the application if you would like the GMP Certificate to be translated. There is an additional fee for the translation. Spanish speaking countries may have Spanish product lists with English/Spanish translation per product. If needed, please provide the product list in this format. Bahrain & Paraguay: can be authenticated as an Apostille or Authority country. Check with your foreign distributor on how to process it.

4 Authority Countries - $345 normal fee (4 weeks) U.S. Arab Chamber of Commerce Stamp (Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Morocco, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, and UAE) Algeria Bahrain* Bangladesh Benin Bolivia Cambodia Canada China Egypt Ethiopia Ghana Guatemala Guyana Haiti Indonesia Iraq Jamaica Jordan Kenya Kuwait Lebanon Libya Malaysia Myanmar Nepal Nigeria** Pakistan Palestine Paraguay* Philippines Qatar (Texas based members only) Saudi Arabia Singapore Sri Lanka South Sudan** Syria Taiwan Tanzania Thailand Tunisia Turkmenistan Uganda United Arab Emirates (UAE) Vietnam Yemen Check this box if you want U.S. Arab Chamber of Commerce Stamp Add l $35.00 for each document, per country **Special Notes for Authority Countries: Nigeria: additional per product fees apply ($15 per product on list) South Sudan: additional fees are required Spanish speaking countries may have Spanish product lists with English/Spanish translation per product. If needed, please provide the product list in this format. Bahrain & Paraguay can be authenticated as an Apostille or Authority country. Check with your foreign distributor on how to process it.

5 Form of Payment Check Enclosed: #: Amount: $ OR Authorization for Credit Card Company Name: Name on Card: Address: Phone: Description (Country and Document Type): Amount: Card Type: Credit Card #: Expiration Date: Security Code Business Credit Card Y N If no, please provide address & phone of credit card holder:

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