**Certificate of Free Sale Request Form**
2015. B
A “Certificate of Free Sale” is a formal affidavit attesting that the products being imported are of
the same quality as those manufactured and “sold freely” in the U.S. PLEASE NOTE: This
document cannot be used as a Certificate of Good Manufacturing Practice (GMP), nor can it be
altered in any way from the original format or language.
The two tier pricing model reflects the authentication requirements of the more than 140
countries ICMAD services. All shipping charges and certification costs are part of the fee. No
additional invoice or shipping charges will apply.
It takes approximately 2-4 business weeks for turnaround.
Please fill out the following information completely. Any missing information will delay the
processing of your Certificate.
Company Name
Manufacturer
Distributor*
*If you are a Distributor please include your Manufacturer’s contact information on
Page 2. Manufacturers MUST be ICMAD members. The FDA’s definition of a
Manufacturer is the company actually filling the product.
Please provide the country name in the spaces below for the type of COFS. Refer to Pages 3 and
4 for country listings.
Apostille $195
Authority $345
Authenticated Non-COFS Export Document (if applicable) $135________ # of Documents ______
(Complete Page 5/see total fees)
Name and address of Member Company contact person to send completed certificate:
Email address:
Mail this form with your completed application and check or credit card authorization to:
ICMAD, 21925 Field Parkway, Suite 205, Deer Park, IL 60010.
Please note: The application must be signed by an officer of the ICMAD member
manufacturer/distributor and must be notarized (see Page 2).
This document should serve as your official INVOICE.
If you have questions, contact Judi Myers |1-847-991-4499 | 1-847-305-2497 | [email protected]
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Certificate of Free Sale Application
(Company name and address typed below will appear as is on the Certificate.)
1)
Name and address of ICMAD Member Manufacturer:
Company
Address
City, State, Zip
Telephone:
2)
Fax:
Name and address of ICMAD Member Distributor (If Distributor is requesting COFS):
Company
Address
City, State, Zip
Telephone:
Fax:
3) Please indicate which company should appear on the Certificate if Distributor is requesting.
4) Cosmetic(s) requiring Certificate: (Please include exact product name and attach list on
letterhead if too large; also include type of cosmetic product i.e. lotion, toner, polish etc.
for ICMAD’s purposes only):
5) ICMAD Member Manufacturer/Distributor certifies that:
a. it abides by all Federal and State regulations relating to the manufacturing and marketing
of this product.
b. its product and manufacturing methods comply with appropriate Good Manufacturing
Practice guidelines.
c. its products are currently sold freely throughout the United States and are the same
products that it intends to export.
Notarized By:
Corporate Executive Signature (Requester)
Title and Date
2
Apostille Countries- $195 fee
Albania
Andorra
Antigua & Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Barbados
Belarus
Belgium
Belize
Bosnia & Herzegovina
Botswana
Brunei Darussalam
Bulgaria
Canada
Cape Verde
Colombia
Cook Islands
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Dominica
Dominican Republic
Ecuador
El Salvador
Estonia
Fiji
Finland
France
FYR of Macedonia
Georgia
Germany
Greece
Grenada
Honduras
Hong Kong
Hungary
Iceland
India
Ireland
Israel
Italy
Japan
Kazakhstan
Kyrgyzstan
Latvia
Lesotho
Liberia
Lichtenstein
Lithuania
Luxembourg
Malawi
Malta
Marshall Islands
Mauritius
Mexico*
Monaco
Mongolia
Montenegro
Namibia
Netherlands
New Zealand
Niue
Nicaragua
Norway
Oman
Panama
Peru
Poland
Portugal
Republic of Moldova
Romania
Russia*—Optional Translation
Yes or No (Add’l fee required)
Saint Kitts and Nevis
ee
in Lucia
Saint
Saint Vincent & Grenadines
Samoa
San Marino
Sao Tome & Principe
Serbia
Seychelles
Slovakia
Slovenia
South Africa
South Korea
Spain
Suriname
Swaziland
Sweden
Switzerland
Tonga
Trinidad & Tobago
Turkey
Ukraine
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Yugoslavia
*Special Notes for Apostille Countries:
Mexico: is only valid for one year.
Russia: translation is now optional. Please mark on the application if you would like that done. There
is an additional fee for translation.
Spanish speaking countries may have Spanish product lists with English/Spanish translation per
product. Please provide the product list this way
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Authority Countries- $345 fee
Algeria
Bahrain
Bangladesh
Benin
Bolivia
Brazil**
Cambodia
Chile
China** – (Add’l fees for Consulate Requests)
Egypt
Ethiopia
Ghana
Guatemala
Guyana
Haiti
Indonesia
Iraq
Jamaica
Jordan
Kenya
Kuwait
Lebanon
Libya
Malaysia
Morocco
Myanmar
Nepal
Nigeria – (Addt’l per product fees apply)
Pakistan
Palestine Paraguay Philippines
Qatar** (COFS only, no docs outside IL)
Saudi Arabia
Singapore
Sri Lanka
S o u t h Sudan (Addt’l fee required)
Syria
Taiwan
Tanzania
Thailand
Tunisia
Turkmenistan
Uganda
United Arab Emirates
Vietnam
Yemen
**Special Notes for Authority Countries:
Brazil: needs an electronic version of the product list to copy and paste into the body of the
certificate. Please email the product list as a Word or Excel document.
China: China now requires that the products are currently being sold in the U.S. Please state
the date of the most recent launch of the product(s) Date:
Qatar: Requires that all requests for authentication of documents (Non-COFS) MUST originate
from the member’s state jurisdiction. As a result, ICMAD can only process document
authentication requests from IL-based members.
Spanish speaking countries may have Spanish product lists with English/Spanish translation per
product. Please provide the product list this way.
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Authentication of Non-COFS Export Documents (If Applicable)
In conjunction with Certificates of Free Sale, ICMAD will authenticate documents that require a
member’s signature for export to the same country corresponding with a current COFS that was
processed by ICMAD. Sample documents include: BSE Certificate, GMP, Certificate of Origin,
Ingredient List, Power of Attorney, etc.
Non-COFS document submissions must be original and contain a member’s original signature and title.
Please do not notarize the documents. ICMAD will notarize them as part of the authentication
process.
Authentication Fees (per COFS-issued country):
 $135.00 For up to three documents per country corresponding to COFS
 $35.00 Each additional document (per same COFS-issued country)
Expedited Service
 Available for Authority Countries only (see list on Page 4)
 $175.00 per document PLUS the standard authentication fees above
 The opt i onal expedited service takes 2-4 business weeks rather than 4-6 business weeks.
Please complete the following for Authentication of Non-COFS Export Documents:
Company Name: _______________________________________
Country: __________________________________ # of Documents: ______________________
Name and address of Member Company contact to send completed document(s):
__________________________________________________________________________________
Email:
______
Non-COFS Export Documents to Authenticate (Please list the full title):
Document Type
Ex. BSE Certificate
Qty
2
Country
Indonesia
Expedited Y/N
Y
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Fee
$135+$175+$175=$485
Form of Payment
Check Enclosed:  #: ________ Amount: $_________
OR
Authorization for Credit Card
Company Name:
Name on Card:
Address:
Phone:
Description (Country
and Document Type):
Amount:
Card Type:
Credit Card #:
:Expiration Date:
Security Code
E-Mail:
Business Credit Card
Y
N
If no, please provide address & phone of credit card holder:
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