Cosmetic Notification - Form

2009

The Cosmetic Notification Form is now available in a fillable PDF format! The form is also available in a word processor format. Please contact the Cosmetics Division at cosmetics@hc-sc.gc.ca or 1-866-662-0666 (toll-free within Canada and the United States) to obtain a copy.

When completing the form, please note:

• Print all forms on 8½ × 11 inch paper;
• Adhere to the spaces provided when entering information; and
• Do not add information to the back of the forms after printing.

For assistance filling out the form, please refer to "Guide for completing Cosmetic Notification Form"

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• Page of Pages
• 1. This notification is:
  • New
  • An amendment
• 2. Do you intend to continue sale of the cosmetic in Canada?
  • Yes
  • No
• 3. Name of the cosmetic
• 4. Manufacturer (Name as on label and full mailing address)
• 5. Other manufacturer (Name and address)
  • Same as manufacturer
  • Other (Specify below)
• 6. Canadian distributor (Name and address)
  • Same as manufacturer
  • Other (Specify below)
• 7. Correspondence to be sent to:
  • 4
  • 5
  • 6
  • Other (Specify below)
• 8. Correspondent
  • Language preference
    • English
    • French
  • Telephone Number
  • Facsimile No.
  • E-mail
• 9. Purpose of cosmetic
  • Code(s)
  • Description
• 10. Form of cosmetic
  • Code
  • Description
• 11. Cosmetic intended for use on
  • Humans
  • Animals
  • Both
• 12. Number of products covered by this notification
  • One
  • Many
• Page of Pages
• 13. Composition
  • Ingredients
  • Concentration
• AUTHORIZED BY
  • Name (please print)
  • Position
  • Relationship of signer to manufacturer
  • Web site / e-mail
  • Signature
  • Date