1.3. Danh sach cdc dang ho^c mau (List of Variants or Shade). T^n (Names)

2. Dgng san pham (Product type(s))

?Kent, nhu tuong, sDa, gel hoac d3u dung tren da (tay, mat, chan,...)Creams, emulsions, lotions, gels and oils for skin (hands, face, feet, etc.)

?Mat na (chi tru san pham lam bong da ngudn goc hoa hoc)Face masks (with the exception of chemical peeling products)

?Cdc chat phu lndu (16ng, nhdo, b^t)Tinted bases (liquids, pastes, powders)

?Phdn trang di^m, phdn dung sau khi thm, bot ve sinh, ....

Make-up powders, after-bath powders, hygienic powders, etc.

?Xaphbngtam, xd phong khtr muiToilet soaps, deodorant soaps, etc

AOHYR

cua

Xu

UN

LG

NN

EO

1)IT

I.II

OGMA

YT

DNA

iC

cs

1.2. T^n sdn ph^m (Product name)

YDNIc

THONG TIN SAN PHAMPARTICULARS OF PRODUCT

1. Tn nh^D hang v& tn san phSm (Name of brand & product):

1.1. Nhan hang (Brand)

PHIEU CONG BO SAN PHAM M^ PHAMTEM PLATE FOR NOTIFICATION OF COSMETIC PRODUCT

Banh diu vdo 6 thlch h<rp (Tick where applicable)

(HOK OFFICIAL USE!

Ngay nhan (Date acknowledged): 1 1 -06" 2015

So cong bo (Product Notification No.):

001895 /15/CBMP-HCMPhiSu c^ng bo c6 gia tri 05 n&m ke tit ngay nhijin.

kt.oi^m d'

PHAN DANH CHO CO OUAN OUAN LY

Pin. luesoOJ-MP

3. Myc dich su dyng (Intended use)Lam sach co thl

?Nude hoa, nude thorn ddng v sinh,....

Perfumes, toilet waters and eau de Cologne^ San pham Ctk t^m hoac goi (mu6i, xa phdng, dSu, gel,....)

Bath or shower preparations (salts, foams, oils. Gels, etc.)

?San pham tay longDepilatories

?San pham khu mui va chong mui.Deodorants and anti-perspirants

D San ph^m clidm soc toeHair care products

-Nhu6m v^ tiy t6c-Hair tints and bleaches-U6n toe, dui t6c, giff np t6c-Products for waving, straightening and fixing,-Cae san pham dinh dang toe

-Setting products,

-San pham lam sach (sffra, hot, dau gdi)-Cleansing products (lotions, powders, shampoos),-Sdn ph^m cung cap chat dinh duSng cho t6c (sffa, kem, dSu),-Conditioning products (lotions, creams, oils),-Ce san pham lao kieu toe (sQa, keo xit toe, sap)

-Hairdrcssing products (lotions, lacquers, brilliantines)D San pham dung cao rau hoac sail khi cao rau (kem, xa phong, s&a,....)

Shaving product (creams, foams, lotions, etc.)

D San pham trang diem va tay trang dung cho mat va mat

Products for making-up and removing make-up from the face and the eyes

?San pham dung cho moiProducts intended for application to the lips

?S^n phim d chiim sdc r^ng vi mi^ng>tProducts for care of the teeth and the mouth

P San pham dung de cham soc va to diem cho mong tay, mong chan.'___

Products for nail care and make-up^D San pham dung dc vc sinh co quan sinh due ngoai^,

Products for external intimate hygieneS^

?San pham chong nang,^Sunbathing products "^

n San pham lam sam da ma khong can tSm n^ng.Products for tanning without sun.

?San pham lam tr^ng daSkin whitening products

?San pham chong nhan daf3E^Anti-wrinkle productsv^—

D San ph^m kh^c (de nghj ghi rO)^Others (please specify)^ ^*

1

Tel:|8|4|-|8|-|3|7|4|2|l|l|0|4| fl Fax:|8|4|-|8|-|3|7|4|2|1|l|0|0|l

)2ii

NMV

U

UCH

H9(K

N1IIH

MaAN

LL(

I

D

MHYT

ACMAI

N

CH

OII

T

THNP

A

N

I0HIE

VHTIIY

CountryP

GU

GNG

HN

N

N9G

AVN0

HH93

TPc9

Dia chi cha cdng ty d6ng gdi (Address of assembler (state countty)):

IASMAHPYMNAHP0CYTGNN

0O

Gc

6. T^n cong ty ddug g6i (d nghi danh diu vao muc thi'ch hgp. C6 th^ d^nh dan nhieu hon 1 6(Name of assembler (Please tick accordingly. May tick more than one box)):

^Bdng g6i chinh^ Dong gdi thi^ cflpPrimary assemblerSecondary assembler

Tnl=|8|4|-|8|-|3|7|4|2|l|l|0|4| I I Fax:|8|4|-|8|-|3|7T4|2|l|l|0|0|

)2n

NM

AVU

UCH

H0(K

N1IIH

M9AN

LL|

i

D

MH

T

ACMAI

N

CH

6H

T

THNp

AEN

I6HIE

VHTHV

CountryP

GU

GNG

HN

N

INOG

AirN0

HH()3

Tpy9

Dja chi nha san xu^t (Ntrac sdn xudt) (Address of manufacturer (state country)):

IASMAHP¥MNAHP6cYTGNN

oO

Gc

i TH6NG TIN VE NHA SAN XUAT/ DONG GOI(D^ nghi dinh k^m danh sach rieng neu nhu c6 nhiu hon mot cong ty tham gia s^n xuat/ d6ng

goi de tao ra mQt san phdm hoan chinh)

i PARTICULARS OF MANUFACTURER(S)/ASSEMBI.F.R(S)(Please attach in a separate sheet if there are more than one manufacturer/assembler)

5. Ten nha san xuat (Name of manufacturer):

rinh bay (Product presentation^))^ Dang don le (Single product)?Mot nhom cac m^u (A range of colours)?Bang cc mau trong mot dang san pham (Palette(s) in a range of one product type)?C^c san pham ph6i hop trong mot bo san ph^m (Combination products in a single kit)?Cac dang khac (de nghj ghi ro). Others (please specify)

Dja chi cdng ty nhap khau (Address of importer):

9. Ten cdng ty nhap khdu (Name of importer):

THdNG TIN Vt CONG TY NHAP KHAUPARTICULARS OF IMPORTER

I I I I I I I TT1|fl|0|C|T|T|0|N|G|

Chijrc vu P cdng ty (Designation in the company):

Email:ph-181-13 742 1104Tel: |8|4

[L|Y| |N|G|n|Y|E|N| |L[A|N| |P|H|G|O|N|G| I I I I I I Inlgll n^sla i |g oln cjo slnJeo|m| I [ 1 I I I I I I I I I I

|0|3|0|0|7|6|7|9|8|4| MM

THONG TIN Vfe NGlTCtt DAI DI^N THEO PHAP LUAT CUA CONG TYPARTICULARS OF PERSON REPRESENTING THE LOCAL COMPANY

8. Hp v& ten (Name of person):

Tel:|8|4|-|8|-|3|7|4|2|l|l|0|4| |~| Fax:|8|4|-|8|-|3|7|4|2|l|l|O|on

So giay ph^p kinh doanh/S6 gi&y ph^p hoat dongBusiness Registration Number/License to Operate Number

)2II

NM

AIJU

UCH

H0(K

NIII

H

M0AN

LLJ

I

D

HYT

CMAJ

CH

OII

T

HNP

AEN

OIIIE

HTHY

P

G11

GNG

HN

N

N0G

AON0

HH03

TPC9

EIja chi cong ty (Address of company):

IASMAHPMYNAHP0CVTGNNo

Gc

7. Ten cong ty (Name of company):

THONG TIN VE T6 CHtfC, CA NHAN CHIU TRACH NHIEMDUA SAN PHAM MY PHAM RA THI TRUCfNGPAR IICULARS OF LOCAL COMPANY RESPONSIBLE

FOR PLACING THE COSMETIC PRODUCT IN THE MARKET

0,90 %

3,15 %

Ti 1^ % cila nhitngchat co giai han venfing dg, hamhrong

Citric Acid

Sodium Chloride

Fragrance

Cocamide DEA

PEG-7 Glyceryl Cocoate

Glycerin

Glycol Distearate

Polyquaternium-7

Disodium Laureth Sulfosuccinate

Cocamidopropyl Betaine

Sodium Laureth Sulfatc

Water

Ten aky ii thanh phan (ttn danh phip qu6c t6 ho}c sit dung ttokhoa hoc chuan da dune c6ng nh^n)Full Ingredient name (use 1NCI or approved nomenclature instandard references)

12

11

10

9

g

7

6

5

4

3

2

1

No

Tel=l I I I I i I I I I I I I I II Fax;|~l IJ I I I I I I IDANH SACH THANHPHAN

PRODUCT INGREDIENT LIST

10. De nghj Idem tra 6 sau day (Please check the following boxes)

^ Toi da kilm tra ban sua doi tir phu fuc II den phu luc Vll cua danh muc cc thanh phln mypham ASEAN nhu dirge cong b^̂ tren ban sura d6i gin d^y nhlt c^^a Hlfp djnh my phamASEAN. Toi xin xac nhan r^ng s^n phlm dirge Ak c^p d^n trong ban cong bo nay khung chuabat cur mot thanh phan bi cam n^o vh cQng tu^n thu voi danh myc h^n che va cac dieu ki^n quidjnh trong cac phu luc.

I have examined the latest revisions of the Annexes II to VII of the ASEAN CosmeticIngredient Listing as published in the latest amendment of the ASEAN Cosmetic Directiveand confirmed that the product in this notification does not contain any prohibited substancesand is in compliance with the restrictions and conditions stipulated in the Annexes.

^ Tfli dam nhan trach nhi^m trh 16i vJl hgp t^c toan dien vdi ca quan co tham quyen v bdt kyhoat dong kilm so^t sau khi ban hang khi co yeu cau bdi co quan co thSm quy^n.

I undertake to respond to and cooperate fully with the regulatory authority with regard toany subsequent post-marketing activity initiated by the authority.

Danh sach th^nh phan day du (product full ingredient list)(Yeu cau ghi day du danh sach tat ca cac thanh ph^n vrl ti 1^ % ciia nhifng ch^t co gidi han venong do, h^im lugng siir dung trong my phdm - To submit ingredient list with percentages ofrestricted ingredients)

XI

CAM KET(DECLARATION)

1.Thay mat cho c6ng ty, toi xin cam k^t san phAm ducrc dA cap trong PhiAu c6ng bo ndy datdu^c tat cd ede yeu cAu cua Hiep dinh my pham ASEAN v^ cdc phy lye ciia no.

I hereby declare on behalf of my company that the product in the notification meets all therequirements of the ASEAN Cosmetic Directive, its Annexes and Appendices.

2.T6i xin chju trdch nhi^m tu^n thft cdc diAu khodn sau day (I undertake to abide by the

following conditions):i. Bdm bdo cd sAn de cung cAp cac thong tin kf thuat va tinh an todn khi ca quan cd tham

quyen yeu cau va co day du ho sa ve cac san pham da dtiQC phdn phoi de bdo cao trongtrirftng hap san phAm phai thu hoi.

Ensure that the product's technical and safety information is made readily available tothe regulatory authority concerned ("the Authority") and to keep records of the distributionof the products for product recall purposes;

ii. Phai thong bdo ngay cho ca quan co tham quyen vA cac tdc dyng phu nghi^m tr^ng1 g^ychtft ngufri hoc de doa tinh m^ng cua san pham bAng dien thoai, fax, thu din t^ hoyc vanbdn trudc 7 ngay kl lif ngay biet thong tin.

Notify the Authority of fatal or life threatening serious adverse event' as soon aspossible by telephone, facsimile transmission, email or in writing, and in any case, no laterthan 7 calendar days after first knowledge;

Hi. Phai hoan thanh b^o cdo tdc dyng phu ciia san pham2 (theo mau quy djnh) trong vdng 8ngay lam viSc kk t^ ng^y thong bao cho ca quan co thAm qu^An vA nhftng tdc dung phynghiem trong nhu da neu trong muc 2ii noi trcn va cung cap bat cur thdng tin ndo theo yeucau ciia ca quan c<5 tham quyen.

Complete the Adverse Cosmetic Event Report Form2 within 8 calendar days from thedate of my notification to the Authority in para 2ii. above, and to provide any otherinformation as may be requested by the Authority;

iv. Thong bao ngay cho ca quan co tham quyAn vA ede phan ling phu nghiem trong nhirngkhong gay chet nguai hoac de doa d^n tinh myng ciia san pham va trong bat cii trudng hapnao, viec bao cao (su: dung mSu bdo cdo) vA tdc dung phy phai duac tien hanh trudc 15ngay k^ tCr ngay biet vA tdc dyng phy nay.

Report to the Authority of all other serious adverse events that are not fatal or lifethreatening as soon as possible, and in any case, no later than 15 calendar days after firstknowledge, using the Adverse Cosmetic Event Report Form;

v. C6ng bo vdi ca quan co tham quyen khi co bat eft sy thay d6i nao trong bdn c6ng bo ndy.Notify the Authority of any change in the particulars submitted in this notification;

3.T6i xin cam doan rAng nhung th6ng tin du^c dua ra trong ban cong b6 nay la dung sir tht. TAtcd ede lai lieu, cac thong tin lin quan dAn nOi dung cong b6 sc diroc cung cAp vd ede tdi HAu

dinh kem la ban hap phdp hodc sao y ban chinh.I declare that the particulars given in this notification are true, all data, and information of

re'evancc in relation to the notification have been supplied and that the documents enclosedarc authentic or true copies.

4.Toi hilu rAng toi s c6 trdch nhiem de dam bao tat ca cac 16 san phAm cua chftng t6i deu dapftng cac yeu cAu phdp luyt, va tuan thu tat ca ticu chudn va chi tieu sdn phAm da du^c cong bovfti ca quan c6 thAm quyen.

0,000375%

0,001125%

Methylisothiazolinone

Methylchloroisothiazolinone

Tocopheryl Acetate

15

14

13

{') Nhu da d^ge djnh nghia r8 r^ng trong lAi li^u hudi^ dBn cho c^c cong ly vS bdo cao lac dung ph^ cua san phin my phim.As defined in Ihe Guide Manual for the Industry on Adverse Event Reporting of Cosmetics Products

(^) Trinh My trong php lye I trong tiii li^u huorng d^n cho c^c cong ty ve h^o cAo ^^c dyng ph^ ciia san phQm mj ph^raSet out in Appendix I to the Guide Manual for the industry on Adverse Event Reporting of Cosmetics Products

Ngay[Date]

Dau ciia cSng ty[Company stamp]

09/06/2015

T6n va chu ky cua ngircri dai dien theo phap luat ciia c5ng ty[Name and Signature of person representing the local company]

Ly Nguy^n Lan Phmmg

I understand that I shall be responsible for ensuring that each consignment of my productcontinues to meet all the legal requirements, and conforms to all the standards and

specifications of the product that I have declared to the Authority.5. Tdi hieu rang trong tnrdng hgp co tranh chap phap luat, toi khon^ dugc quyen sur dung b^n

cong b& sin phim m phim da dirge ca quan co thim quy6n chap nhan nu sin phim ciiachung t6i khong dat dirge cac yeu cau vc tieu chuan, chi tieu ma chung tSi di c6ng bo.

I understand that I cannot place reliance on the acceptance of my product notification bythe authority in any legal proceedings concerning my product, in the event that my producthas failed to conform to any of the standards or specifications that I had previously declaredto the Authority.