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Form 42 - Application Form For Issue Of Registration Certificate For Import Of Cosmetics Into India

“Form 42

(See rule 129 A)

Application for issue of Registration Certificate for import of cosmetics into India under the Drugs

and Cosmetics Rules, 1945.

I/We*_____________________________________________ (Name and full address) hereby apply for the grant of

Registration Certificate to the manufacturer, M/s ___________________________ (full address with telephone,

fax and e-mail address of the foreign manufacturer) for his manufactured cosmetics meant for import into

India.

1. Names of cosmetics along with their brand name and pack size(s) and variants for registration.

(1)

(4)

(2)

(5)

(3)

(6)

2. I/We* enclose herewith the information and undertaking specified in Schedule D (III) duly signed by

the manufacturer for grant of Registration Certificate for the premises stated below:-

3. A fee of ____________________ for registration of cosmetics for import as specified at serial number .2

above has been credited to the Central Government under the Head of Account “0210-Medical and Public

Health, 04-Public Health, 104-Fees and Fines" under the Drugs and cosmetics Rules, 1945 – Central”

vide Challan No., dated, (attached in original).

4. Particulars of premises to be registered where manufacture is carried on:

Address (es) :_______________________________

Telephone :_______________________________

Fax :_______________________________

E-mail :_______________________________

I/we undertake to comply with all the terms and conditions required to obtain Registration Certificate and

to keep it valid during its validity period.

Place:

Date:

Signature________________________________

Name____________________________________

Designation_____________________________

Seal/Stamp of manufacturer or his authorized

agent in India.

(Note:- In case the applicant is an authorized agent of the manufacturer in India, the Power of Attorney is to

be enclosed) *Delete whichever is not applicable.

Form 42 - Application Form For Issue Of Registration Certificate For Import Of Cosmetics Into India