CHALICE VITALCHEM PRIVATE LIMITED

Format No.: QAS003/F/04/00 Reference SOP No.: SOP/QA/003/00

Complaint Reply Form
Effective Date: Page 1 of 2

Complaint No.:
Date of complaint Received: ______________

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 

Brief Description of Complaint:

Reply:
 CHALICE VITALCHEM PRIVATE LIMITED

Format No.: QAS003/F/04/00 Reference SOP No.: SOP/QA/003/00

Complaint Reply Form
Effective Date: Page 2 of 2

QA Head
Sign/Date: