SUE FORM B: TRANSMISSION OF SUE BY COMPETENT AUTHORITY TO OTHER COMPETENT AUTHORITIES AND RESPONSIBLE PERSON (according to Article 23 of Regulation

(EC) No 1223/2009 on cosmetic products) 1) Case report Competent Authorit Case !dentification Num"er# Report t pe# !nitial $ollo%&up $inal 'ate recei(ed " Competent Authorit # // )ending date to the other Competent Authorities/Responsi"le *erson# // 2) Compete t A!t"or#t$ +em"er )tate# Competent Authorit name# Address and local contact details# %) S!spe&te' pro'!&t $ull name# Compan # Notification num"er# () Compete t A!t"or#t$ s!mmar$ a) Narrat#)e *) Fo++o,-!p

&) Respo s#*+e Perso &a!sa+#t$ assessme t ,er li-el .i-el Not clearl attri"uta"le /nli-el E0cluded /nassessa"le

') Compete t A!t"or#t$ &a!sa+#t$ assessme t .#/ appropr#ate) ,er li-el .i-el Not clearl attri"uta"le /nli-el E0cluded /nassessa"le

e) Corre&t#)e a&t#o s 1es /) Comme ts

No If yes , specify #

0) Atta&"me ts 2 3 form A 2 3 other#4444444

,ersion# 11 5ul 2013