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OVER-THE-COUNTER PRODUCTS
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FEEDBACK FORM
COMPLAINT FORM
DRUG SAFETY
Feedback Form
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COMPLAINTS MANUAL SUBMISSION
DOWNLOAD
Sector
*
Government
Private
Institution
Product Name
*
Product Code
*
Batch No.
*
Supplier / Manufacturer
*
Expiry Date
*
Affected Quantity
*
Delivery Order No.
*
Complaint Details
*
Product
Item Delivery / Acceptance
Others
Product
*
Drug
Medical Device
Raw Material
Short Supplied
Over Supplied
Damaged
Wrongly Supplied
Item Not Received
Wrongly Delivered
Others
Complaint Description
*
Replacement
*
Required
Not required
Attachment
*
Complainant Details
Name
*
Position
*
Organisation
*
Phone No.
*
Email
*