Adverse Event or Product Complaint Intimation Form

Name: Country:
Contact Number: Email:

*Date of receipt of Complaint:
*Product Name and Stregth:
*Description Of Complaint:
Batch Number:
Manufacturing Month: Manufacturing year:
Expiry Month: Expiry Year:
*Complaint received from:-
Doctor: Patient: Retailer:
Warehouse: Stockist: Torrent Employee:
Contacts Details Of source of Complaint:-
Complaint Sample Received:
Enter Image Text Code Here :