CHALICE VITALCHEM PRIVATE LIMITED

Format No.: QAS003/F/02/00 Reference SOP No.: SOP/QA/003/00

Internal Memorandum
Effective Date: Page 1 of 2

This is to inform you that we have received complaint as per details given below, your assistance is required in
complaint investigation.

Date of complaint Received: Complaint No.

Complaint Product Details: Name and Address of Complainant:
Product Name:
Batch No.:
Mfg./Exp.:
Name of Party:

Nature of Complaint: Product Defect  Packaging Defects 

Adverse Drug Reaction  Other  -specify

Type of complaint: Critical  Major  Minor 

Department Sign/date

Production

Quality Control

Warehouse

Maintenance

Other
 CHALICE VITALCHEM PRIVATE LIMITED

Format No.: QAS003/F/02/00 Reference SOP No.: SOP/QA/003/00

Internal Memorandum
Effective Date: Page 2 of 2

QA Head
Sign/Date