P H A N D A N H C H O CO Q U A N Q U A N L Y

( F O R O F F I C I A L USE) p.
Ngay nhan (Date received): ^'
So c6ng bo (Product Notification No.):
39823/11/ CBMP-QLD

PHIEU C O N G B O SAN PHAM M Y PHAM

TEMPLATE FORNOTIFICATION O F COSMETIC PRODUCT

1-L.CUC TRUUNG
0 Danh dau vao 6 thich hop (Tick where applicable)
i^. TRICING PBDNG
THONG TIN SAN PHAM
. PARTICULARS OF PRODUCT

1. Ten nhan hang va ten San phdm (Name of brand & product) :

1.1 Nhan hang (Brand)

BIZWOMAN

1.2 Ten san phim (Product Name)

BIZWOMAN
NATURAL-BORN S I L K Y T W O - W A Y SPF 30
1.3 Danh sach cac dang hoac mau (List of Variants or Shade). Ten (Names):

2. Dang san ph^m (Product type(s))

• Kem, nhiJ tuong, sua, gel hoac dau dung tren da (tay, mat, chan, ....)
• Creams, emulsions, lotions, gels and oils for skin (hands, face, feet, etc.)
. • Mat na (chi trijr san pham lam bong da nguon g6'c hoa hoc)
• Face masks (vk'ith the exception of chemical peeling products)
• Cac chat phii mau (long, nhao, bot)
• Tinted bases (liquids, pastes, powders)
0 Cac pha'n trang diem, pha'n diing sau khi tSm, bgt ve sinh, ...
• Make-up powders, after-bath powder, hygienic powders, etc.
• Xa phong tSm, xa phong khirmui,..
• Toilet soaps, deodorant soaps, etc.
• Nuofc hoa, nudfc thorn dung ve sinh,.
• Perfumes, toilet waters and eau de Cologne
• Cac san pham de tam hoac goi (muoi, xa phong, ddu, gel,.)
• Bath or shower preparations (salts, foams, oils, gels, etc.)
• San pham tay long
• Depilatories •
• Chat khii mill va chong miii. "
• Deodorants and anti-perspiranls
• Cac .san pha'm cham soc toe
D Hair care products
C O G I A T R I 03 N A M
KFTli'NGA.YNHAN
 - nhu6m va tay toe
- hair tints and bleaches
- thu6'c u6'n toe, du6i toe, gitt nep toe
- products for waving, straightening and fixing,
- cac san pham djnh dang toe
- setting products,
-cac san ph^m lam sach (sua, bot, d&u goi)
- cleansing products (lotions, powders, shampoos),
- San ph^m cung cS'p chat dinh duong cho toe (sua, kem, dau),
- conditioning products (lotions, creams, oils),
- cac san ph^m tao kieu toe (sua, keo xjt toe, sap)
- hairdressing products (lotions, lacquers, brilliantines)
• San ph^m dung cao rSu (kem, xa phong, sua,...)
• Shaving product (creams, foams, lotions, etc.)
0 Cac san ph^m trang diem va tay trang dung cho mat va mSt
• Products for making-up and removing make-up from the face and the eyes
• Cac san phim diing cho moi
• Products intended for application to the lips
• Cac san pham de cham soc rang va mieng
• Products for care of the teeth and the mouth
• Cac san ph^m diing de cham soc va t6 diem cho mong tay, mong chan.
• Products for nail care and make-up
• Cac san pham dung de ve sinh ben ngoai
• Products for external intimate hygiene
0 Cac san ph^m chS'ng nSng
• Sunbathing products
• San ph^m lam sam da ma khong cSn tarn nang.
• Products for tanning without sun.
• San ph^m lam trang da
* • Skin whitening products
• San ph^m chong nhan da
• Anti-wrinkle products
• San ph^m khac (de nghj ghi ro)
• Others (please specify)

Muc dich sir dung (Intended use)

Diing trang diem, chong nang.

Dang trinh bay (Product presentation(s))

0 Dang don le (Single product)
• Mot nhom cac mau (A range of colours)
• Bang cac mau trong mot dang san ph^m (Palette(s) in a range of one product type)
• Cac san ph^m phoi hop trong m6t bo san phdm (Combination products in a single kit)
• Cac dang khac (d6 nghi ghi ro). Others (please specify)

, THONG TIN V E NHA SAN XUAT/ DONG GOI

(De nghj dinh kem danh sach rieng neu nhu c6 nhifiu hon mot cong ty san xua't/ dong goi)
 'PARTICULARS OF MANUFACTURER (S)/ASSEMBLER(S)
(Please attach in a separate sheet i f there are more than one manufacturer/assembler)

Ten nha san xua't (Name of manufacturer) : •

SAMSUNG COSMETICS

Dia chi nha san xua't ( Nudfc san xua't) (Address of manufacturer (state country)):

#263-35, GAJ WA-DONG, SEO-GU, INCHEON, K O R E A

COUNTRY: K O R E A

6. Ten cong ty dong goi (de nghj danh dau vao muc thi'ch hop. Co the danh da'u nhieu hon 1 6
(Name of assembler (Please tick accordingly. May tick more than one box)):

0 Primary assembler • Secondary assembler

• Dong goi chinh • Dong goi thu ca'p

SAMSUNG COSMETICS

Dia chi nha san xua't ( Nuoc san xua't) (Address of manufacturer (state country)):

' #263-35, GAJ WA-DONG, SEO-GU, INCHEON, K O R E A

COUNTRY: K O R E A

THONG T I N V E TO CHU'C, CA NHAN CHIU T R A C H NHIEM

DlTA SAN PHAM M Y PHAM RA THI T R U I N G

' A nuinufmlurev is a lonipciny wliich is engaged in any proiess carried ont in llu-1 onrse of making the cosmetic product.The mamifactnring process

includes all operations of purchase of starting materials, hulk intermediates and prodin ts.fornndalion and production (such as grinding, mixing,

encapsulation and/or packaging), cpudity control, release, storage and distribution of costnetic products and the related controls.

Cong ty san xua't Ici cong ty tham gia vao hat ky giai doan nuo cua qua trinh tao ra .vin pham my jyliam. Qua trinh .san .fudt bao gom tat cd cac giai

dogn lif mua ngnyen lieu, .san xua't ban thanh phc'nn va thanh pham, xdy dung cong thuc vd sdu xudt ( vi du fihu nghien, trgn, goi va hoac dong goi).

kiem tra chat ti/g'ng, xua't xu'cfng, bao qiidn , phan phoi va cac qua trinh kiem socit lien quan.

A primary as.iembler is a company which is engaged in a process of enclosing the product in a primary/immediate container which is labelled or to be

labelled before the product is .mid or supplied in it.

Cong ty dong goi cin'nh la cong ty tham gia vao qua trinh dong goi san pham vao bao hi dong goi tnfc chinhl true liep, bao In iiay ditgc hoac se ditac

dan nhan tntac khi san pham ditcfc ban hoac phan phoi.

Aji^i^MlXi'J.^lllllLCL " <' company which is engaged only in a process of labelling the product coiUaiiier where the product is already enclo.sed in

its primaly container andlor packing the product which is already enclo.sed in its labelled pi imary routaiiier into a carton which is labelled or to be

labelled, before the product is sold or supplied.

Cong ty dong goi thifcup Id cong ty chi tham gia vdo qua trinh dan nhan cho bao goi md sdu pliani da dugc dong vao trong bao goi chinh , hoac dong

bao goi chinh vdo tiong hop carton, sctu do dan iihdn. tritac khi ban hoac phan plidi.

3
 P A R T I C U L A R S O F L O C A L COMPANY RESPONSIBLE
FOR PLACING T H E C O S M E T I C PRODUCT IN T H E M A R K E T

7 Ten cong ty (Name of company):

C O N G T Y T R A C H N H I E M HCTU H A N

MOT THANH VIEN NHAT PHAN

- ' •' -s -
Dja chi cong ty (Address of company):

SO 388, DtTOTVG NGUYEN AI QUOC, P H U d N G TAN T I E N ,

THANH PHO B I E N HOA, TINH DONG NAI
COUNTRY: V I E T NAM
T E L : 0985.585.554

Business Registration Number/License to Operate Number (if applicable, submit a copy of the Business
Registration Certificate):
So giay phep kinh doanh/So giay phep hoat dong (neu c6 the, nop ban sao ciia giay phep kinh
doanh)

3602432845

THONG TIN V E NGUOl DAI DIEN CHO CONG TY TAI DIA PHUDNG
PARTICULARS O F PERSON R E P R E S E N T I N G T H E L O C A L COMPANY

8. Ho va ten (Name of person):

PHAN THI DIEM SUONG

T E L : 0985.585.554

Chile vu or cong ty (Designation in the company):

GIAMDOC
Ghi chu: Neu cong ty cong bo la cong ty dugc iiy quyen hai chu sb Ma san pham thi phai trinh thu
iiy quyen va bat ky cac thong tin khac c6 lien quan k h i dugc yeu cau bcfi ca quan quan ly.
Note: I f the applicant is a service provider authorised by the company, he is required to provide a
letter of authorisation or any additional particulars as required by the regulatory authority.

THONG TIN VE CONG TY NHAP KHAU

PARTICULARS OF IMPORTER
9. Ten cong ty nhap kh^u/Name of Importer:

• CONG TY TRACH N H I E M HlTU HAN V .•

 Dja chi cong ty (Address of company):

SO 388, DlTOTVG N G U Y E N AI QUOC, PHUOfNG TAN T I E N ,

THANH PHO BIEN HOA, TINH DONG NAI
COUNTRY: V I E T NAM

T E L : 0985.585.554
•, > •

DANH S A C H T H A N H PHAN '

PRODUCT INGREDIENT LIST

10. De nghi kiem tra 6 sau dSy (Please check the following boxes)

0 Toi da kiem tra ban sira d6i tir phu luc 11 den phu luc V I I ciia danh muc cac thanh pbin my pham
ASEAN nhu dugc cong bo tren ban sira doi gan day nhat ciia Hiep dinh my ph^m ASEAN. Toi xin
xac nhan rang san pham dugc de cap den trong ban cong bo nay khong chiia bat cu: m6t thanh ph&n hi
cS'm nao va cung tuSn thij vdfi danh muc han che va cac dieu kien qui dinh trong cac phu luc.
1 have examined the latest revisions of the Annexes I I to VII of the ASEAN Cosmetic Ingredient
Listing as published in the latest amendment of the ASEAN Cosmetic Directive and confirmed that
the product in this notification does not contain any prohibited substances and is in compliance with
the restrictions and conditions stipulated in the Annexes.

0 Toi dam nhSn trach nhiem tra lofi va hgp tac toan dien vdri co quan c6 tham quydn vi bat ky hoat
d6ng kiem soat sau khi ban hang khi co yeu cau boi ca quan co tham quy^n.

I undertake lo respond to and cooperate fully with the regulatory authority with regard to any subsequent
post-marketing activity initiated by the authority.
Danh sach thanh phan day du (product full ingredient list)
(Yeu cAu ghi dSy du danh sach thanh phan va ti le phan tram ciia ta't ca cac thanh ph^n trong c6ng tMc san
pham my phdm - The list and percentage of all ingredients)

Ten d'iy du thanh phSn (tSn danh phap quoc te hoac ,str dung ten khoa hoc chuan da duoc cong nhSn)
No
Full Ingredient name (use I NCI or approved iiomenclafure in standard references)

Full Ingredient name Percentage

1 MICA 31.000000
2 TALC 28.060000
3 SILICA 10.000000
4 TITANIUM DIOXIDE (CI 77891) 8.500000
5 METHICONE 8.500000
6 DIMETHICONE 5.000000
7 SQUALANE 3.000000
8 IRON OXIDES (77492) 2.400000
9 DIISOSTEARYL MA LATE 2.000000
10 IRON OXIDES (77499) 0.600000
11 IRON OXIDES (77491) 0.500000
12 ALLANTOIN 0.100000
13 FRAGRANCE O.I 00000
14 METHYLPARABEN 0.100000

c
 15 TOCOPHERYL ACETATE 0.100000
16 PROPYLPARABEN 0.040000
TOTAL 100.000000

Cam ket ( D E C L A R A T I O N )
1. Thay mat cho c6ng ty, t6i xin cam ket san pham dugc 6i cap trong don c6ng bd nay dat dugc ta't ca cac
yeu cin trong Hudtig dan My ph^m ASEAN va cac phu luc ciia no.
/ hereby declare on behalf of my company that the product in the notification meets all the requirements
of the ASEAN Cosmetic Directive, its Annexes and Appendices.
1. Toi xin chiu trach nhiem tuSn thii cac dieu khoan sau day (I undertake to abide by the following conditions):
i. Dam bao co sSn de cung ca'p cac thong tin ky thuat va ti'nh an toan khi co quan co th^m quyen yeu cdu
va CO dSy dii h6 so ve cac san ph^m da dugc phan phoi de bao cao trong trudng hgp san pham phai thu
hoi.
Ensure that the product's technical and safety information is made readily available to the regulatory
authonty concerned ("the Authority") and to keep records of the distribution of the products for
product recall purposes;
ii. Phai thong bao ngay cho co quan co tham quyen v6 cac tac dung phu nghicm trong gay chet nguofi
hoac de doa ti'nh mang ciia san pham bang dien thoai, fax, thu dien tir hoac van ban tru6c 7 ngay ke tijf
ngay bife't th6ng tin.
Notify the Authority of fatal or life threatening serious adverse event^ as soon as possible by telephone,
facsimile transmission, email or in writing, and in any case, no later than 7 calendar days after first
knowledge;
iii. Phai hoan thanh bao cao tac dung phu ciia san ph^m (theo mSu quy dinh) trong vong 8 ngay lam viec
ke th ngay th6ng bao cho co quan co th^m quy6n ve nhung tac dung phu nghiem trgng nhu da neu
trong muc 2ii noi tren va cung ca'p ba't cu thong tin nao theo yeu cau ciia co quan co tham quyen.
Complete the Adverse Cosmetic Event Report Form'' within 8 calendar days from the date of my
notification to the Authority in para 2ii. above, and to provide any other information as may be
requested by the Authority;
iv. Thong bao ngay cho co quan co tham quyen v6 cac phan ling phu nghiem trgng nhung khong gay chet
nguofi hoac de doa den tinh mang ciia san phim va trong ba't cu" truofng hgp nao, viec bao cao (sir dung
mSu bao cao) vi tac dung phu phai dugc tien hanh truofc 15 ngay ke tir ngay biet vi tac dung dung phu
nay.
Report to the Authority of all other serious adverse events that are not fatal or life threatening as soon
as possible, and in any case, no later than 15 calendar days after first knowledge, using the Adverse
Cosmetic Event Report Form;
V. Cong bd vdfi co quan cd tham quyfin khi cd bat ciI sir thay ddi nao trong ban cong bd nay.
Notify the Authority of any change in the particulars submitted in this notification;
3. Toi xin cam doan rSng nhitng thdng tin dugc dua ra trong ban cong bd nay la diing sir that. Ta't ca cac tai
lieu, cac thdng tin lien quan den ndi dung cong bd se dugc cung ca'p va cac tai lieu dinh kem la ban hgp phap
hoac sao y ban chinh.
/ declare that the particulars given in this notification are true, all data, and information of relevance in
relation to the notification have been supplied and that the documents enclosed are authentic or true copies.
4. T6i hieu rSng tdi se cd trach nhiem de dam bao ta't ca cac id san ph^m ciia chiing tdi deu dap ling cac yeu
c^u phap luat, va tuan thii ta't ca tieu chudn va chi tieu san pham da dugc cong bdvdi coquan cd th^m quydn.

- Nhu' da dirac dinh nghia ro rang trong tai liiiu huding dSn cho cac cong ty vc bao cao tac diing phii ciia san pham my phSm.
As clefiiied in the Guide Manual for the Indiisny on Adverse Event Reportini' ofCosnieli<s Products
' Trmh bay Irong phu lyc 1 trong tai Win hirong dfin clio cac cong ly vc bao cao tac dung pliii cua saii pliam my phfiin.
Set ont in Aiipendix 1 lo the Guide Maniud for the Industry ou Adverse Evenl Reporting of Cosmetics Products
 / understand that I shall he responsible for ensuring that each consignment of my product continues 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. Toi hieu rang trong truomg hop co tranh chap phap luat, t6i khdng dugc quyen sijr dung ban c6ng bo cha't
luomg san phim da dugc co quan c6 th^m quyen cha'p nhan nd'u phim cua chiing toi khdng dat dugc cac y€u
cSu \6 tidu chu^n, ch: tieu ma chiing tdi da cong bd.
/ understand that I cannot place reliance on the acceptance of my product notification by the authority in any
legal proceedings concerning my product, in the event that my product has failed to conform to any of the
standards or specifications that I had previously declared to the Authority.

Ten va chif ky ciia ngudi dai dien cho cong ty tai dia phuong
[Name and Signature of person representing the load company]

Ngay 28 thang 01 namJOff^l?^

G I A M D6C/%^:-'^~-^"^\=->N .

PHAN THI DIEM SlTOfNG^:^