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Note for Guidance for Food Contact Materials
Page 70 of 126
Annex 6 to Chapter III
MODEL FOR A PETITIONER SUMMARY DATA SHEET ("P-SDS")


SUBSTANCE (1)................................................................................................................................................

USE OF SUBSTANCE
(2)..........................................................................................................................................
REF.N
.(3).....................................................................................................................................

CAS.N...............................................................................................................................................

SOCIETY(4) ........................................................................................................................................................

PERSON RESPONSIBLE FOR THE TECHNICAL DOSSIER.......................................................

ADDRESS OF THE RESPONSIBLE PERSON..............................................................................
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PHONE.....................................FAX..............................E_MAIL......................................................

Where the technical dossier does not contain all the requested data (see below) give reasons:
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(1)
Indicate first the most common chemical name of the substance or, in the case, of a substance
included in the Directive 2002/72/EC the name given in this Directive.

(2)
Specify whether it is monomer or additive.

(3)
REF.N. = Substance Reference Number. Indicate this number if it has been given to the substance
under examination.

(4)
Company on behalf of which the dossier is submitted.