www.amalabs.com • +1.845.634.4330

Please contact us to discuss specific or unique protocol needs.

Clinical Safety & Claims • Photobiology Testing • Other Panel Studies F.D.A. Registered - ISO 9001 Certified

Please fill out both pages of the Sample Submission Form and send the completed form along with your sample(s) to216 Congers Road Building 1, New City, New York 10956 to the attention of the Sample Submission Department.

SAMPLE SUBMISSION FORM

COLIPA European/ Global Harmonization/ International

SPF ISO 24444 International StandardFDASPF TESTING:

StaticWater Resistant 40 MinuteWater Resistant 80 Minute

Static

Water ResistantVery Water Resistant

Static

StaticWater Resistant: Minute

AS/NZ Australian/ New Zealand

Panel Size: 1 subject 2 subjects 3 subjects 5 subjects 10 subjects

Please provide the expected SPF value:

* 100 grams requested

IN-VIVO UVA TESTING:UVA ISO 24442 International Standard

Please provide the expected PFA value:

* 100 grams requested

Panel Size: 1 subject 2 subjects 3 subjects 5 subjects 10 subjects

IN-VITRO UVA TESTING:FDA Critical WavelengthCOLIPA European/ International

Please provide the labeled SPF value:Boots Star Rating System

UVA ISO 24443 International StandardPlease provide the measured SPF static value:

AS/NZ Australian/ New ZealandPlease provide the measured SPF static or water resistant value:

* 100 grams requested

INFRARED TESTING:In-vitro IRPFIn-vivo IR

* 100 grams requested

Panel Size: Subject(s)

SAMPLE DESCRIPTION:

Company Name:Contact Name:

Email:

Phone:

QTY:Please provide the description to be used in the report. Include a unique identifying number (Lot, Batch, Formula or Study)

CLIENT INFORMATION:

Address:

City:

State:

Country:

Postal Code:

Please include only one product per submission form.

Page 1 of 2 F-013 Sample Submission Form Rev 12

O�cial Use Only

Please provide use instructions:

Time Points: Panel Size: Subject(s)

For testing requested above please fill out the fields listed below:

Skin Lightening via Chromameter

Skin Elasticity and Firmness via CutometerTransepidermal Moisture Loss (TEML) via DermaLab Evaporimeter

Skin Surface Hydration via Corneometer

Subjective Questionnaire addressing user perceivedbenefits

PhotoGrammetrix Analysis, PhGx ®

EFFICACY TESTING:Skin Sebum via Sebumeter

Surface Evaluation of Living Skin (SELS) via VisioscanSkin Moisturization - Electroconductivity via Novameter

Matched Scientific Photography, MSP™

PhotoAllergy MaximizationPhotoToxicity

ComedogenicitySAFETY TESTING:

RIPT24 Hour Patch48 Hour Patch

Panel Size:50 subjects 100 subjects

Cumulative Patch Panel Size:

20 subjectsPanel Size:

6 subjects

Panel Size:20 subjects

Panel Size:25 subjects* RIPT - 400 grams requested

* 24hr/48hr - 100 grams requested

* 200 grams requested * 100 grams requested

* 100 grams requested * 200 grams requested

Diluted to %

Plastic Surgeon

* 100 grams requested * 100 grams requested

Ophthalmology**Panel Size:

60 subjects30 subjects

Panel Size:

10 subjects5 subjects

Panel Size:

10 subjects5 subjects

Facial Sting AssayEye Sting Assay

**Please provide use instructionsfor Vaginal Irritation/Opthamology:

Vaginal Irritation**

** Individual units in sufficient quantities according to use instructions and the duration of the study

Panel Size:

10 subjects5 subjects

DermatologistPediatrician Gynecologist

Signature:For the testing requested above please fill out the applicable fields listed below:

Patch Configuration:OccludedSemi-OccludedOpen

Dilution:Undiluted

Distilled waterOther

Antiperspirant Testing Deodorant TestingAxilla Foot Other

Panel Size: Subject(s)

Test Site:Time Points: 1 Hour 24 Hours 48 Hours 72 Hours Other

Male FemaleGender:

Please contact us to discuss specific or unique protocol needs.

Date:Submitted by/Authorized Signature:

www.amalabs.com • +1.845.634.4330

SAMPLE SUBMISSION FORM

Clinical Safety & Claims • Photobiology Testing • Other Panel Studies F.D.A. Registered - ISO 9001 Certified

Page 2 of 2 F-013 Sample Submission Form