COSMOS STANDARD
PRODUCT QUESTIONNAIRE
DOC. NR
GP 24 F05
DATE
01.04.2016
REV. NR
01
PAGE
1/6
160 Sokak 13/7 35040 Bornova – Izmir Tel: 0232-3397606, Fax: 3397607, [email protected]
I-General information about your company and your product:
Trade Name
Raw Material/Ingredient Manufacturer Company
Address
Post code
City, Country
Contact person
Tel/Fax:
E-mail:
Supplier/Distributor (if different indicate also address,
telephone, fax) :
Application Scope – Başvuru Kapsamı:
Please indicate the scope(s) you apply for certification: Sertifikasyon için başvuru yaptığınız kapsam(lar)ı işaretleyiniz:
Certification of organic and/or natural cosmetic products.
Organik ve/veya doğal kozmetik ürünlerin sertifikasyonu
Certification of chemically processed agro-ingredients with organic content.
Kimyasal işlemlerle muamele edilen organik tarımsal girdilerin sertifikasyonu.
Approval of ingredients with no organic content.
Organik içeriği olmayan girdilerin onaylanması.
Minerals and ingredients of mineral origin (Cosmos Appendix IV)
Mineral ve mineral kökenli girdiler (Cosmos Ek IV)
Physically processed agro-ingredients (plant, animal, or microbial)
Fiziksel yöntemlerle elde edilmiş tarımsal-girdiler (bitki, hayvan veya mikrobiyal)
INCI denomination :
CAS Number :
Category / Function:
Agricultural Ingredients
Processing Aids
Chemical formula:
This questionnaire must be completed by the manufacturer of the product; Information given is under his own responsibility.
COSMOS STANDARD
PRODUCT QUESTIONNAIRE
DOC. NR
GP 24 F05
DATE
01.04.2016
REV. NR
01
PAGE
2/6
160 Sokak 13/7 35040 Bornova – Izmir Tel: 0232-3397606, Fax: 3397607, [email protected]
II -Reagents origin and manufacturing processes:
1. Chemically processed ingredients:
For each chemically processed agro-ingredient, answer the following questions: (Example: Glyceryl
Stearate)
A - Origin of Reagents and Solvents used for manufacturing
For each reagent and solvent used in the manufacturing process, fill the following table (all requested
percentages must be expressed in weight, add lines if necessary)
(Example: Glycerylstearate, 10%)
Chemical
% Natural Origin
Petroch*
Contained Additives
Manufacturing
Name and
Vegetable**
%
(antioxidants,
process
CAS n.
Animal Mineral
preservatives etc.)
Name and CAS %
* If your ingredient is constituted or contains a synthetic moiety as authorized in the Standard, appendix VI, specify
hereby the presence percentage of this moiety (on the active matter Molecular Weight), as well as the ingredient
involved
**All plants used as raw materials for reagents or solvents used for manufacturing should meet the CITES
requirements (Convention on International Trade in Endangered Species of Wild Fauna and Flora). Join, for all plants
used as raw materials, your declaration indicating :
plant name
origin of plant (country)
Indicate for each of the following processes whether it enters in the manufacturing of used
reagents or solvents :
YES
NO
Ethoxylation :
Irradiation :
Sulfonation :
Techniques using genetic manipulations :
Ethylene oxide treatment :
Treatment using mercury :
Petrochemical catalysis
Extraction :
(Specify the solvents used for extraction)
Solvent Recovery (Extracting agent removal)
Do you use the following products among your reagents?
YES
NO
MEA, DEA, TEA
Are all raw materials in biotechnologic processes GMO free?
This questionnaire must be completed by the manufacturer of the product; Information given is under his own responsibility.
COSMOS STANDARD
PRODUCT QUESTIONNAIRE
DOC. NR
GP 24 F05
DATE
01.04.2016
REV. NR
01
PAGE
3/6
160 Sokak 13/7 35040 Bornova – Izmir Tel: 0232-3397606, Fax: 3397607, [email protected]
B-Origin of manufacturing auxiliaries
Indicate for each of the following processes whether it enters in the production process of the auxiliaries used for
manufacturing the ingredient to be validated (pH adjuster, catalyst …) :
YES
NO
Ethoxylation :
Irradiation :
Sulfonation :
Techniques using genetic manipulations :
Ethylene oxide treatment :
Treatment using mercury :
Petrochemical catalysis
Extraction :
(Specify the solvents used for extraction)
Solvent Recovery (Extracting agent removal)
Do you use the following products among your reagents?
YES
NO
MEA, DEA, TEA
C- Manufacturing process of the product to be validated:
Manufacturing process description (Use block diagram below or join flow chart)
(Example : fatty acid production)
*Please see attached processing flow chart
Indicate for each of the following processes whether it enters in the product manufacturing
YES
NO
Ethoxylation :
Irradiation :
Sulfonation :
Techniques using genetic manipulations :
Quaternization of
Ethylene oxide treatment :
Treatment using mercury :
Petrochemical catalysis
Use of solvents for the manufacturing and the purification of
your chemically transformed ingredient
In that case, do you use aromatic, halogenated, sulfured, or
nitrogened solvents
(Specify the solvents used for extraction)
Solvent Recovery (Extracting agent removal)
YES
NO
Hydrogenation
Hydrolysis
Esterification
Etherification
Sulphatation
Fermentation
Indicate for each of the following processes whether it enters in the product manufacturing:
This questionnaire must be completed by the manufacturer of the product; Information given is under his own responsibility.
COSMOS STANDARD
PRODUCT QUESTIONNAIRE
DOC. NR
GP 24 F05
DATE
01.04.2016
REV. NR
01
PAGE
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160 Sokak 13/7 35040 Bornova – Izmir Tel: 0232-3397606, Fax: 3397607, [email protected]
Indicate the percentage of Active Matter of your chemically transformed ingredient:
D- General questions regarding the principles of green chemistry:
■
Atoms economy principle: last reaction’s output
R= (mass of the wanted product/mass of all products)*100
What is the result? (must be specified for all chemically processed agro-ingredients)
R = (26,7/27,1)*100= % 98,52
■During the manufacturing of your chemically transformed ingredient, are there temporary modifications
(e.g. protection/deprotection of functional groups) ?
YES
NO
■
YES
Have you set up a procedure to reduce the number of these temporary modifications?
NO
■
Do the manufactured ingredient meet the requirement of the Cosmos Standard as regards
biodegradability and aquatic toxicity ?
YES
NO
E - Other questions:
1)
If your manufactured ingredient contains a synthetic moiety, as authorized in the Standard,
appendix VI, specify hereby the presence percentage of this moiety (on the active matter), as well as the
ingredient involved - Example :
Example : Cocoamidopropylbetaine CAS N° 61789-40-0, Molecular Weight: 342 Synthetic Moiety
:Molecular weight : 159 Petrochemical % = 159/342 = 45.2 %
2)
Additives : List of additives (antioxidants, preservatives etc.) contained in the
manufactured ingredient. Add lines if necessary
Chemical Name and
Function
Synthetic
Origin
Natural*
Weight
%
-
2. Physically processed ingredients:
A-Plant ingredients:
List here all the plant ingredients used for manufacturing, the used weight percentage and the
manufacturing processes that were needed for their preparation. All plants used as raw materials should
meet the CITES requirements (Convention on International Trade in Endangered Species of Wild Fauna
and Flora ). Add lines if necessary:
Name
Percentage
Contained Additives
(antioxidants,
preservatives etc.)
Manufacturing
Chemical
process
name
%
(Example: Sunflower Oil Extract of Sida Ruta : 10% )
This questionnaire must be completed by the manufacturer of the product; Information given is under his own responsibility.
COSMOS STANDARD
PRODUCT QUESTIONNAIRE
DOC. NR
GP 24 F05
DATE
01.04.2016
REV. NR
01
PAGE
5/6
160 Sokak 13/7 35040 Bornova – Izmir Tel: 0232-3397606, Fax: 3397607, [email protected]
YES
NO
Have a solvent of petrochemical origin been used for obtaining these
ingredients:
- Are any of the ingredients listed above irradiated
If yes, which ones (specify the type of irradiation also): If yes, which
one
Solvent Recovery (Extracting agent removal)
Join, for all plants used as raw materials, your declaration indicating :
Plant name
Origin of plant (country)
B-Animal origin ingredients:
List here all ingredients from animal origin present in your manufactured product and their percentage.
Add lines if necessary:
Name
Percentage
Contained Additives Manufacturing Chemical
%
(antioxidants,
name
process
preservatives etc.)
YES
NO
Are the ingredients listed above entailing the death of the
animal
Have a solvent of petrochemical origin been used for
obtaining these ingredients
If yes, which one are any of the ingredients listed above
irradiated
Solvent Recovery (Extracting agent removal)
C-Mineral origin ingredients: (Enclose MSDS or granulometric analysis indicating minimum particle
size for TiO2, ZnO, CeO2, Silica)
List here all ingredients from mineral origin of your raw material and their percentage, as well as the
physical processes that were needed for their preparation. Add lines if necessary:
Name
Percentage
Manufacturing Impurities
Chemical ppm
process
name
YES
NO
Are any of the ingredients listed above irradiated
If yes, which ones (specify the type of irradiation also)
Are all the ingredients listed above present in the appendix
VI of the Standard
If no, specify which ones
This questionnaire must be completed by the manufacturer of the product; Information given is under his own responsibility.
COSMOS STANDARD
PRODUCT QUESTIONNAIRE
DOC. NR
GP 24 F05
DATE
01.04.2016
REV. NR
01
PAGE
6/6
160 Sokak 13/7 35040 Bornova – Izmir Tel: 0232-3397606, Fax: 3397607, [email protected]
Must these ingredients be labelled as nanoparticles on the
cosmetic products
according to the 1223/2009/CE European Cosmetic
Regulation definition
If yes, which ones
D. Manufacturing process of the product to be validated:
Manufacturing process description (Use Block diagram below or join flow chart)
3-Additives (Preservatives, antioxidants etc):
List here all additives present in your manufactured ingredient and their percentage. Add lines if
necessary :
Chemical Name and CAS n.
Function
Synthetic
Origin
Natural
Weight %
III Environmental data:
General:
YES
NO
Have you evaluated and established a procedure for limiting
accident risks (human
and environmental
If yes, please detail these measures:
Have you evaluated and established a procedure for the
management of waste
production (recycling and others) in the manufacturing of this raw
material or for
your manufacturing plant in general
If yes, please detail these measures
Have you evaluated and established a procedure for energy
economy in the manufacturing of this ingredient or for your
manufacturing plant in general
If yes, please detail these measures
I under signed “………………”, representing the company, “…………………”, declare that
the information given in this questionnaire is correct. Issued in, “……………….”, on the
Obligatory signature (preceded by the mention « read and approved »)
Name Responsible and Signature
Place / Date:
This questionnaire must be completed by the manufacturer of the product; Information given is under his own responsibility.