<p>Cover letter (Office use only) Reception No. Reception Date</p><p>Date:</p><p>To Secretariat of Japanese Cosmetics Federation</p><p>Application form for Japanese Labeling Name of Cosmetic Ingredient</p><p>We hereby apply the Japanese Labeling Name of Cosmetic Ingredient. The details are attached in separate sheet.</p><p>Company Name: </p><p>Address:</p><p>Name of Person in Charge:</p><p>Signature: </p><p>Telephone Number: </p><p>Fax Number: </p><p>E-mail address: </p><p>Remarks: 1. Application documents are to be distributed within Japanese Cosmetic Labeling Name Nomenclature Subcommittee (hereinafter referred Subcommittee) for the purpose of examination of the application; they will not be copied, nor stored outside of JCIA Secretariat. In an eventual case where the disposal of the documents is necessary, they will be disposed at JCIA Secretariat responsibility. 2. Other than facts known to public, members of Subcommittee as well as JCIA Secretariat have duty of confidentiality regarding the information given related with the application.</p><p>Main Sheet (Office use only) Reception No.</p><p> Please check the corresponding case.</p><p>A. INCI name to be translated into Japanese Labeling Name is already listed in ICID and Handbook.  INCI NAME (ICID version ):  Japanese Suggested Name:</p><p>B. INCI Name to be translated into Japanese Labeling Name is already assigned at CTFA, but is not listed on the ICID & Handbook yet.  INCI NAME:  Japanese Suggested Name:</p><p>C The case of a new ingredient which has not INCI Name. Prior to application to JCIA, applied to the IN Committee of CTFA for INCI.</p><p>Regarding this application, Wish to assign the Japanese labeling name to the ingredient, after getting INCI name.</p><p>Wish to assign the Japanese labeling name to the ingredient before getting INCI name.</p><p> Product Name:  Japanese Suggested Name:</p>