Product Complaint Form

Family Name

First name, Middle name

Organization

Country

Address 1

Address 2

Phone number

Product Stream

Fax

FEEDBACK/COMPLAINT REFERENCE OR SUBJECT

(e.g. WHO prequalification reference number or subject text)

Email address

Area(s) and/or process(es):

Dossier assessment

Inspection

Lab testing/performance evaluations

Correspondences

Other: Specify

Feedback/complaint description

Submitted attachments

To be used for reference or as evidence
One file only.
30 MB limit.
Allowed types: jpg, jpeg, png, pdf.