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      COMPLAINTS MANUAL SUBMISSION

        Sector*

        GovernmentPrivateInstitution

        Product Name*

        Product Code*

        Batch No.*

        Supplier / Manufacturer*

        Expiry Date*

        Affected Quantity*

        Delivery Order No.*

        Complaint Details*

        ProductItem Delivery / AcceptanceOthers

        Product*

        DrugMedical DeviceRaw Material

        Short SuppliedOver SuppliedDamagedWrongly SuppliedItem Not ReceivedWrongly DeliveredOthers

        Complaint Description*

        Replacement*

        RequiredNot required

        Attachment*

        Complainant Details

        Name*

        Position*

        Organisation*

        Phone No.*

        Email*