**Certificate of Free Sale Request Form** 2015. B 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. It takes approximately 2-4 business weeks for turnaround. Please fill out the following information completely. Any missing information will delay the processing of your Certificate. Company Name Manufacturer Distributor* *If you are a Distributor please include your Manufacturer s contact information on Page 2. Manufacturers 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 $195 Authority $345 Authenticated Non-COFS Export Document (if applicable) $135 # of Documents (Complete Page 5/see total fees) Name and address of Member Company contact person to send completed certificate: Email address: Mail this form with your completed application and check or credit card authorization to: ICMAD, 21925 Field Parkway, Suite 205, Deer Park, IL 60010. 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 Judi Myers 1-847-991-4499 1-847-305-2497 jmyers@icmad.org 1
Certificate of Free Sale Application (Company name and address typed below will appear as is on the Certificate.) 1) Name and address of ICMAD Member Manufacturer: Company Address City, State, Zip Telephone: Fax: 2) Name and address of 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 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) Title and Date 2
Apostille Countries- $195 fee Albania FYR of Macedonia Oman Andorra Georgia Panama Antigua & Barbuda Germany Peru Argentina Greece Poland Armenia Grenada Portugal Australia Honduras Republic of Moldova Austria Hong Kong Romania Azerbaijan Hungary Russia* Optional Translation Bahamas Iceland Yes or No (Add l fee required) Barbados India Saint Kitts and Nevis Belarus Ireland Saint Lucia Belgium Israel Saint Vincent & Grenadines Belize Italy Samoa Bosnia & Herzegovina Japan San Marino Botswana Kazakhstan Sao Tome & Principe Brunei Darussalam Kyrgyzstan Serbia Bulgaria Latvia Seychelles Canada Lesotho Slovakia Cape Verde Liberia Slovenia Colombia Lichtenstein South Africa Cook Islands Lithuania South Korea Costa Rica Luxembourg Spain Croatia Malawi Suriname Cyprus Malta Swaziland Czech Republic Marshall Islands Sweden Denmark Mauritius Switzerland Dominica Mexico* Tonga Dominican Republic Monaco Trinidad & Tobago Ecuador Mongolia Turkey El Salvador Montenegro Ukraine Estonia Namibia United Kingdom Fiji Netherlands Uruguay Finland New Zealand Uzbekistan France Niue Vanuatu Nicaragua Venezuela Norway Yugoslavia *Special Notes for Apostille Countries: Mexico: is only valid for one year. Russia: translation is now optional. Please mark on the application if you would like that done. There is an additional fee for translation. Spanish speaking countries may have Spanish product lists with English/Spanish translation per product. Please provide the product list this way 3
Authority Countries- $345 fee Algeria Bahrain Bangladesh Benin Bolivia Brazil** Cambodia Chile China** (Add l fees for Consulate Requests) Egypt Ethiopia Ghana Guatemala Guyana Haiti Indonesia Iraq Jamaica Jordan Kenya Kuwait Lebanon Libya Malaysia Morocco Myanmar Nepal Nigeria (Addt l per product fees apply) Pakistan Palestine Paraguay Philippines Qatar** (COFS only, no docs outside IL) Saudi Arabia Singapore Sri Lanka South Sudan (Addt l fee required) Syria Taiwan Tanzania Thailand Tunisia Turkmenistan Uganda United Arab Emirates Vietnam Yemen **Special Notes for Authority Countries: Brazil: needs an electronic version of the product list to copy and paste into the body of the certificate. Please email the product list as a Word or Excel document. China: China now requires that the products are currently being sold in the U.S. Please state the date of the most recent launch of the product(s) Date: Qatar: Requires that all requests for authentication of documents (Non-COFS) MUST originate from the member s state jurisdiction. As a result, ICMAD can only process document authentication requests from IL-based members. Spanish speaking countries may have Spanish product lists with English/Spanish translation per product. Please provide the product list this way. 4
Authentication of Non-COFS Export Documents (If Applicable) In conjunction with Certificates of Free Sale, ICMAD will authenticate documents that require a member s signature for export to the same country corresponding with a current COFS that was processed by ICMAD. Sample documents include: BSE Certificate, GMP, Certificate of Origin, Ingredient List, Power of Attorney, etc. Non-COFS document submissions must be original and contain a member s original signature and title. Please do not notarize the documents. ICMAD will notarize them as part of the authentication process. Authentication Fees (per COFS-issued country): $135.00 For up to three documents per country corresponding to COFS $35.00 Each additional document (per same COFS-issued country) Expedited Service Available for Authority Countries only (see list on Page 4) $175.00 per document PLUS the standard authentication fees above The optional expedited service takes 2-4 business weeks rather than 4-6 business weeks. Please complete the following for Authentication of Non-COFS Export Documents: Company Name: Country: # of Documents: Name and address of Member Company contact to send completed document(s): Email: Non-COFS Export Documents to Authenticate (Please list the full title): Document Type Qty Country Expedited Y/N Fee Ex. BSE Certificate 2 Indonesia Y $135+$175+$175=$485 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 E-Mail: Business Credit Card Y N If no, please provide address & phone of credit card holder: 6