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''AnnexureI

APPLICATION FORM F'OR MARKETING AUTHORIZATION

1. Applicant (Manufacturer, Local distributor, Holder'ol'the Marketing Authorization ) :

Local Distributor
Name AngelBossGroupCo.Ltd
Address No. 79Bc,KampucheaKrornSt.(128),MorroromPhnomPenlr,
Kingdomof Carnbodia
Phone 85523 883 817
Fax 8s5 23 88r 785

Holder of the Marketing Authorization


Name : K-Link InternationalSdn Bhd
Address WismaK-Link,45 Jalan Kr"rchai
Maju2, Off JalanKuchail,arna
58200KualaLumpur,Malaysia
Plrone 60379482333
Fax 60319482338

2, Manufacturer:
Name PT.Nova ClremieUtarna
Address Jl. Suci Km.24, Cijantung,.lakartaTimur, DKI Jakarta,Indonesia
Phone +62218400784 '
Fax +622t 84i I 173

3. Information on the product..

Commercialname : K-OMEGASeUA
Galenicform : Softgelcapsule

4. Qualitative and quantitative formula

a. Active I redient
No. Approved Name LocaUlltell-known Colour/Form Quantityper
Name dosageform
ber soflsel cunsule)
Omega3 - EPA 40%I Omega3 Clear,yellow liquid 500 mg
DHA 30% IDHA3O%-EPA40Yo
2. Squalene
Oil Squalene
Oil Clearliquid, almost 497 mg
colourless,
slightly
odour
3. VitaminE (Natural) VitaminE Brownliquidoil 3mg

b. Exci
No. Approved Name Purposeforinclusion Quantity per dosageform
ber softsel csnsu.le)
Gelatin C a p s u l es h e l l 600 ms
2. Gl yc er in Plasticizers in capsuleshell I JJ nl g
Methvl Paraben Preservativein capsuleshell 0.33 ms
A
Eth yl V anilline Flavorin cansuleshell 0.33 ma
Purified water Processing air to rnakethe shell 380 ms

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