Request to add a substance to the Permitted Substances
list
Requester’s name and
designation
Company/organisation name and
address
Contact phone number and email
address
Name of the substance
Scientific name (Latin binomial)
(if applicable)
Other names for the substance
(if known, each name on a separate line)
Chemical Abstract Services (CAS)
number
(if applicable)
Name of reference publication /
internet database
(that mentions the substance)
The substance is used as an active ingredient
☐
excipient
☐
(please tick where applicable)
List all proposed routes of
administration for this substance
List all proposed dosages /
strengths for this substance
Proposed label advisory or
warning statements
Parts of the plant / animal /
organism used
Method of manufacture /
extraction / purification
NHP permitted substances list request
Page 1 of 2
Request to add a substance to the Permitted Substances
list
List the extraction solvents used
(other than ethanol and/or water)
(if applicable)
Toxicity or safety data to support the use of the substance at the proposed doses and
routes of administration is attached.
Yes
☐
No
☐
Reports of adverse events associated with the use of this substance are attached.
Yes
☐
No
☐
Please remember to attach all reports.
Send to:
naturalhealthproducts@moh.govt.nz
NHP permitted substances list request
Page 2 of 2