Unique IDName* First Last Email* Phone*Legal Business Name* Business Address* Street Address City State Zip Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Type*ManufacturerSupplierWebsite/URL* Google Shopping Merchant Name* Google Merchant Center ID* Mask Standard*Please select oneKN95KF94FFP2Item Standard Code listed in the MFDS database* If 1) you only provide shipping to the European Union and/or the United Kingdom, 2) you obtained testing results from the list of labs listed in Appendix A, and 3) your masks have been tested for filtration efficiency (penetration of filter material sodium chloride test) within a year from the date of your application (no earlier than one year from your date of submission), you have the option to bypass sending samples of your masks to our partner lab provider, SGS, to get tested. In order to take advantage of this option, you will be required to request your lab service provider directly forward LegitScript a copy of the test results for your FFP2 masks. Please note, that if you do not meet all of the above conditions, then testing from SGS is required to complete the review of your application. Please select one of the below:* I meet the above conditions and will request that my lab service provider forward my FFP2 mask test results to LegitScript. I would like to request testing service from LegitScript’s lab testing service provider, SGS. Appendix A Do you only provide shipping to the European Union and/or the United Kingdom?* Yes No Since you do not provide shipping to only the EU or the UK, testing with our lab partner, SGS, is required. Please continue filling out the form.Has your FFP2 mask been tested by one of the following labs?*Please select oneA.N.C.I. SERVIZI S.R.L. -- cimac.itAENOR INTERNACIONAL, S.A. (Unipersonal) -- aenor.comAFNOR Certification -- afnor.orgAPAVE SUDEUROPE SAS -- apave.comASOCIACION DE INVESTIGACION DE LA INDUSTRIA TEXTIL -- aitex.esASQUAL -- asqual.comBSI Group The Netherlands B.V. -- bsigroup.comBundesamt für Eich- und Vermessungswesen -- bev.gv.atCCQS Certification Services Limited -- ccqs.co.ukCENTER FOR TESTING AND EUROPEAN CERTIFICATION Ltd. -- ctec-sz.comCENTEXBEL (WETENSCHAPPELIJK EN TECHNISCH CENTRUM VAN DE BELGISCHE TEXTIELNIJVERHEID - DIVISIE GENT) -- centexbel.beCENTRALNY INSTYTUT OCHRONY PRACY - PANSTWOWY INSTYTUT BADAWCZY (CIOP-PIB) -- ciop.plCENTRO NACIONAL DE MEDIOS DE PROTECCION-INSTITUTO NACIONAL DE SEGURIDAD Y SALUD EN EL TRABAJO -- insst.es/epiCIS INSTITUT, tehnično preizkušanje in analiziranje, d.o.o. -- cisinstitut.siCTI-CEM International Ltd -- cti-cem.comCTV - Certificação de Têxteis e de Vestuário, Unipessoal, Lda. -- ctv-certificacao.ptDEKRA Testing and Certification GmbH -- dekra-testing-and-certification.deDGUV Test Prüf- und Zertifizierungsstelle Fachbereich Rohstoffe und chemische Industrie der Deutschen Gesetzlichen Unfallversicherung e.V. (DGUV) -- bgrci.deDOLOMITICERT S.C.A.R.L. -- dolomiticert.itEurofins Product Testing Italy S.r.l. -- tech.eurofins.itFORCE Certification A/S -- forcecertification.comGÉPTESZT Termelőeszközöket Felülvizsgáló és Karbantartó Kft. -- gepteszt.huHOHENSTEIN LABORATORIES GmbH & Co. KG -- hohenstein.deINSPEC International B.V. -- inspec-international.comINSTITUT PRO TESTOVÁNI A CERTIFIKACI, a. s. (INSTITUTE FOR TESTING AND CERTIFICATION) merged with ex-NB 1390 -- itczlin.czINTERTEK Italia S.p.A. -- intertek.itITALCERT SRL -- italcert.itITEC - ISTITUTO TECNOLOGICO EUROPEO DI CERTIFICAZIONE S.r.l. -- itec-cert.itInstitut für Arbeitsschutz der Deutschen Gesetzlichen Unfallversicherung (IFA) Prüf- und Zertifizierungsstelle im DGUV Test -- dguv.de/ifaaInstitutul National de Cercetare Dezvoltare pentru Protectia Muncii - I.N.C.D.P.M. "Alexandru Darabont" -- inpm.roInstitutul National de Cercetare-Dezvoltare pentru Securitate Miniera si Protectie Antiexploziva -- insemex.roInstytut Technologii Tekstylnych CERTEX Sp. z o.o -- ittcertex.plKR HELLAS LTD. -- krhellas.comLEITAT Technological Center - Acondicionamiento Tarrasense -- leitat.orgLGAI TECHNOLOGICAL CENTER, S. A.(Applus+) -- appluslaboratories.comLOTRIČ Meroslovje d.o.o. -- lotric.siMNA LABORATUVARLARI SANAYI TICARET LIMITED ŞIRKETI -- mnalab.comMTIC InterCert S.r.l. -- mtic-group.orgPOLSKI REJESTR STATKOW S.A. -- prs.plQuintin Certifications -- quintincertifications.frRINA Services S.P.A. -- rina.itRISE Research Institutes of Sweden AB -- ri.seSGS FIMKO OY -- sgs.fiSzutest Uygunluk Değerlendirme A.Ş. -- szutest.com.trTURKISH STANDARDS INSTITUTION (TSE) -- tse.org.trTÜV NORD CERT GmbH -- tuev-nord-cert.deTÜV Rheinland InterCert Muszaki Felügyeleti és Tanúsító Korlátolt Felelosségu Társaság -- tuv.huTÜV Rheinland LGA Products GmbH -- tuv.com/safetyVojenský technický ústav, s. p. -- vtusp.czVyzkumny ustav bezpecnosti prace, v. v. i. -- vubp.czift Rosenheim GmbH -- ift-rosenheim.deÖTI - Institut für Ökologie, Technik und Innovation GmbH -- oeti.bizBSI Assurance UK Ltd -- bsigroup.comCCQS UK LTD -- ccqs.co.ukCertdolomiti Ltd -- certdolomiti.comFleetwood Test House, Blackpool And The Fylde College -- blackpool.ac.ukINSPEC International Ltd. -- inspec-international.comITS Testing Services (UK) Ltd -- intertek.comProduct Assessment and Reliability Centre Ltd, Trading as PARC -- parctest.co.ukSATRA Technology Centre Ltd -- satra.comSGS United Kingdom Limited -- sgs.co.ukShirley Technologies Limited Trading as BTTG -- bttg.co.ukTUV Rheinland UK Ltd -- tuv.comTUV SUD BABT -- tuvsud.comUL International (UK) LTD -- ul-europe.comNo, I did not obtain lab results from the labs above.Since you did not obtain your test results from one of the listed labs, testing with our lab partner, SGS, is required. Please continue filling out the form.Did you obtain your lab results within a year from the date of your application (i.e. no earlier than one year from your date of submission)?* Yes No Since you did not obtain your test results within the last year, testing with our lab partner, SGS, is required. Please continue filling out the form.Yes, Congratulations! You may proceed by requesting your lab provider email LegitScript a copy of your lab results. We will send you a form via email from maskreview@legitscript for you to attach to your request to your lab service provider. Please make sure to attach this form to your request, and ask your lab service provider to attach the form to the email with your test results, and email it to LegitScript at maskreview@legitscript.com. Failure to do so may result in your request being delayed, suspended, or rejected by LegitScript (even if your lab provider has forwarded your lab results to us). Only lab test results from the lab who processed your filtration tests will be accepted. LegitScript will not accept lab results sent to us directly from you (the merchant), or any other entity in the chain of commerce. Mask Product Details Please only submit one Mask Product at a time. Submit a new form for each additional Mask Product.Product Listing/URL* Manufacturer* Authorized Product Name* Model Number* As only one mask product can be submitted at a time, please include no more than one model number in this field.Image of Packaging (URL link)* Credible Documentation Showing Chain Of Custody From OEM (URL link)* Global Trade Item Number (GTIN)* For more information about GTINs, please see the Google Merchant Center Help page.Do you ship to the US?*YesNoMask Testing Sample DetailsMask Color*Please select oneWhiteBlackGrayYellowRedBlueGreenBrownPinkOrangePurpleMask Dimensions (mm)* Country of Origin* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mask Material Composition* Fabric Reference Code If unsure of the code, please list the materials. For more information, please see our FAQ.Production Date* Month Day Year Expiration Date* Month Day Year Lot Number Has this product been sterilized by ethylene oxide:*YesNoMask Testing Payment InformationDun & Bradstreet Number (Optional) Account Payable (AP) Contact InformationAP Contact Name* First Last AP Contact Email* AP Contact Phone*AP Contact FaxSelf-Attestation* I attest my company does not source materials or masks that use modern slavery or labor camps.Merchant represents and warrants that it complies, and shall take all reasonable steps to ensure that its suppliers comply, with all applicable wage and hour, child labor, anti-slavery, and human trafficking laws. Merchant shall not engage in human trafficking or use child or forced labor in connection with its products manufactured or offered for sale. Merchant shall notify LegitScript in the event it suspects, or becomes actually aware of, the use of any child, slave, or other forced labor in the supply chain, manufacture, or sale of its products.Data Consent* By checking this box, you consent to the following:The use of your data, including personal data, for the purposes of evaluation, processing, and as described in LegitScript’s Privacy Policy. By checking this box you also consent to such data being shared with Google.Testing Consent* By checking this box, you consent to the following:Our testing partner, SGS, will contact you shortly with details on the testing process and payment. Please note, all applicable products are required to be tested by our partner lab -- preexisting test results will not be considered or reviewed. You agree to submit the minimum number of samples, in unopened final packages, as required by SGS. You will provide the minimum number of samples required in as-stored/as-sold condition. For example, if 20 samples are required for testing, but you offer the mask for sale in packaging containing 15 masks, you must submit two packages of 15 masks. You understand and acknowledge that all samples will be destroyed after testing. You understand and acknowledge that additional transportation and administrative fees (up to USD $200) may apply to samples provided for testing without all required information or that are sent to the incorrect location. You agree that you are responsible for complying with all applicable importation and customs laws and regulations. You represent and warrant that you are in accordance with the governmental laws and regulations of the countries in which the mask samples shipments originate and terminate, and that you are not prohibited by any such laws and regulations. You represent and warrant that you have, or will secure, any necessary import, export, or other required licenses or certificates for the import or handling of the supplied mask testing samples. You represent and warrant that all mask testing samples have been promptly procured. You represent and warrant that all applicable foreign and domestic laws and regulations in regard to the shipment and importation of the mask samples have been or will be promptly and fully complied with. You irrevocably release all parties involved, including, but not limited to, LegitScript LLC, SGS, their successors, parent or affiliated companies, and assigns from any and all liability, claims, demands, costs and damages of any kind, whether arising from tort, contract or otherwise, which may hereinafter accrue, arise from, or are in any way related to your submission of mask testing samples. You understand and acknowledge that SGS will share the results of your product tests with LegitScript, and LegitScript will use those results during its review.This application form is only considered complete, and LegitScript's review will not begin, when and until we receive full and correct application form information and any necessary successful testing results.