PRODUSEN

FORMULIR ISIAN DATA PERUSAHAAN

PRODUSEN KOSMETIKA (PK)

1. Nama Perusahaan : ________________________________________

2. Alamat Kantor : ________________________________________
________________________________________
3. Telepon : (____) ____________ Faximile: (____) ________
4. E-mail : ________________________________________
5. Alamat Pabrik : ________________________________________
________________________________________
6. Telepon : (____) ___________ Faximile : (____) ________
7. E-mail : ________________________________________
8. Web site : ________________________________________
9. Sosial Media : ________________________________________
10. Status Perusahaan : PMDN PMA Terbuka
11. Pimpinan Perusahaan/Jabatan : ________________________________________
12. Direktur/Manager R&D : ________________________________________
Marketing : ________________________________________
Produksi : ________________________________________
Lainnya : ________________________________________
13. Sertifikat yang telah dimiliki : ________________________________________
14. Merk Dagang :
Licensed Product : ________________________________________
Owned Product : ________________________________________
15. Jenis Usaha : Produksi Sendiri Toll Manufacturing

16. Jenis Produk (beri tanda  pada kotak yang tersedia di bawah ini yg sesuai dengan produk
perusahaan anda)
 Creams,emulsions,lotions,gels and oils for the skin
(hands, face, feet, etc)  Shaving products (creams, foams, lotions, etc).
 Face masks (with the exception of peeling products).  Products for making up and removing make-up from
 Tinted bases (liquids, pastes, powders). the face and the eyes.
 Make-up powders, after-bath powders, hygienic  Products intended for application to the lips.
powders, etc.  Products for care of the teeth and the mouth.
 Toilet soaps, deodorant soaps, etc.  Products for nail care and make-up
 Perfumes, toilet waters and eau de Cologne.  Products for external intimate hygiene.
 Bath and shower preparations (salts, foams, oils,  Sunbathing products.
gels, etc).  Products for tanning without sun.
 Depilatories.  Skin-whitening products.
 Deodorants and anti-perspirants.  Anti-wrinkle products.
 Hair care products :  Lain-lain : ____________________________

17. Catatan/Data Tambahan : ________________________________________

___________________________________________________________________
Jakarta, _______________ 20__
Pimpinan Perusahaan,

(_________________________)
nama, tandatangan dan cap stempel