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Questionnaire for non organic raw material new version

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Questionnaire for non organic raw material new version Powered By Docstoc
					F349(GL)v04.1en                                   ECOCERT Greenlife                                     01/08/2013

Questionnaire for the non organic raw material verification
   according to the Ecocert natural and organic cosmetic
                         standard
This questionnaire must be completed and signed by the manufacturer of the raw material;
                    Information given is under his own responsibility.
                   TDS and MSDS must be joined to this questionnaire.

 COMMERCIAL NAME:



I – GENERAL INFORMATION about your company and your product:

    1. Manufacturer:
       Name of the company:
       Address:


         Phone:                                                    Email:
         Fax:

    2. Supplier/Distributor, if different:
       Name of the company:
       Address:


         Phone:                                                    Email:
         Fax:

    3. Category/Function:

    4. Chemical formula:

    5. CAS number:

    6. INCI name:



II – INGREDIENTS AND REACTANTS:

    1. Origin and manufacturing processes:

Please list exhaustively in the table below each ingredient (active ingredient or solvent)
of the commercial reference mentioning:
- its name
- its origin (plant/marine, mineral, animal, synthetic)
- its manufacturing process*
- the reactants used, their origin (plant/marine, mineral, animal, synthetic) and their
manufacturing process*
- the content (%) in the commercial reference

*In case of ingredients or reactants coming from biotechnological process, please precise the
substrate and the culture medium composition.

This document is property of ECOCERT.
Any reproduction whether in whole or in part of this document, without written consent from ECOCERT is illegal.   Page 1 on 4
 F349(GL)v04.1en                                   ECOCERT Greenlife                                     01/08/2013



Name of the                                                                                Reactants (origin and
                       Origin               Manufacturing process                                                                %
 ingredient                                                                               manufacturing process)
                                                                                   Glycerol (Saponification of a
                                                                                   vegetable oil)
 Example:
                                      Esterification of glycerol and               Stearic acid (Saponification,
  Glyceryl              Plant                                                                                                    25
                                      stearic acid                                 neutralisation and distillation
 stearate
                                                                                   without solvent of a vegetable
                                                                                   oil)

 Example:
  Lemon                 Plant         Hydrodistillation                            Lemon zest (plant, grinding)                  5
essential oil

 Example:
                     Synthetic        X                                            X                                             2
sorbic acid




      A. Auxiliaries:

     Definition: Component intentionally used in necessary and sufficiency quantity to allow,
      facilitate and optimize a step of the manufacturing process of an ingredient but that you
      don’t find in the final ingredient
     Example: catalyst

 Are manufacturing auxiliaries used during the                                YES      NO
 synthesis of the ingredients listed previously?                          If yes, which ones:


 Are the manufacturing auxiliaries removed in a
 purification step?                                                           YES          NO


 Are the manufacturing auxiliaries detectable by                             YES      NO
 analysis?                                                                If YES, precise the component(s) and
                                                                          content(s):


      B. Plant ingredients (physically transformed):

 Is a petrochemical solvant used for the                                      YES      NO
 manufacturing of these ingredients?                                      If yes, which one:


 For an aqueous extract, what is the result of the ratio: quantity of dry plant used / quantity of
 final extract obtained after filtration?:
 As a reminder: dry plant = fresh plant / 4


 This document is property of ECOCERT.
 Any reproduction whether in whole or in part of this document, without written consent from ECOCERT is illegal.   Page 2 on 4
F349(GL)v04.1en                                   ECOCERT Greenlife                                     01/08/2013

    C. Mineral ingredients (physically transformed) and ingredients from
       mineral origin (chemically transformed):

Are these ingredients considered as                                          YES      NO
« nanomaterials » according to the definition of the                     If yes, which ones:
Regulation (EC) n° 1223/2009 on cosmetic
products?


    D. Animal ingredients and ingredients from animal origin:

Are some ingredients used for the manufacturing of                           YES      NO
the commercial reference part of the animal?                             If yes, which ones:
Example: enzyme


If an ingredient from animal origin is used, has it                          YES      NO
caused the stress, the pain or the death of the                          If yes, which one:
animal?



    2. Additional questions:

    A. Forbidden processes ans components:

Can you confirm that the forbidden processes below are not used during the manufacturing
process of the ingredients contained in the commercial reference, the obtention of the
reactants or the manufacturing process of the auxiliaries? YES   NO

Bleaching on an animal support                                   Treatment using mercury (mercurial soda or
                                                                 potash)
Deodorisation on an animal support                               Use of ethylene oxide
Irradiation (ionizing rays: alpha, gamma)                        Use of formaldehyde
Sulphonation (except for the auxiliaries)                        Quaternisation of amines

If NO, precise the ingredient(s) concerned and the reaction(s) involved:


Do you use the following components among your reactants: MEA, DEA, TEA?                                      YES         NO


    B. Derived GMO:

Are the plants used in the manufacturing process of your
commercial reference, as ingredient, reactant or solvent,                               YES          NO
guaranteed GMO-free?


For biotechnological process:
Are all raw materials of the biotechnological process                                   YES          NO
PCR(-)?




This document is property of ECOCERT.
Any reproduction whether in whole or in part of this document, without written consent from ECOCERT is illegal.   Page 3 on 4
F349(GL)v04.1en                                   ECOCERT Greenlife                                     01/08/2013


    3. Additives:

Are additives added to the commercial reference?:                                YES          NO

If YES, precise which ones, their name, origin, manufacturing process and content (%):

Preservatives:


Antioxidants:


Other additives :



    4. Secondary components and impurities:
Indicate for each of the following constituents whether it enters the commercial reference (as
a component or by-product) and if there is no data, please indicate « ? »:
                                                                         YES
                                                                                                   NO                   ?
                                                                   (content in ppm)
1.4-Dioxane
Ethylene oxyde
Propylene oxyde
                     Amidoamine (>0,5%):
Free amines:
                     Monoethanolamine (>0,5%)

Heavy metals (cadmium, mercury, antimony,
arsenic, chromium, cobalt, nickel, lead, silver)
concentration > 10 ppm :

Pesticides (-, -, -HCH, DDT, DDE,
dichlofenthion, PCBs)
Aromatic hydrocarbon


Other residues or impurities (names, origins, manufacturing processes and contents (%)):




I undersigned,     ,   representing the company,                        ,    declare that the information given in
this questionnaire is correct.


Issued in       , on      .


Signature compulsory (with the sentence « read and approved »)




This document is property of ECOCERT.
Any reproduction whether in whole or in part of this document, without written consent from ECOCERT is illegal.   Page 4 on 4

				
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