Customer Quality Complaint Form

* Indicates a required field

Distributor name or Company name

PO Number

Email

Phone number

Simport Invoice Number

Item Number (Simport Product Code)

Lot Number(s) and Quantity Related to the Request

Indicate all lot numbers related to this request and the quantity for each lot.

Type of issue reported

Description of the reported issue

Please provide a clear, detailed and concise description of the reported issue. Specify when and how it was observed and indicate, if applicable, any recent changes to your equipment or procedures.

Photos or videos of the product concerned and other relevant documentation

Please attach photos or videos of the product concerned, as well as any other relevant documents or information related to your request. corresponding to each photo or video. A sample return may be required.

Example – PJ Label

Example of the PJ label to photograph.

Upload a photo of the PJ label

Please upload a clear photo of the PJ label, as shown in the example above.

Example – Eti-Lot Card

Example of the Eti-Lot card. Please ensure that the employee number is clearly visible.

Upload a photo of the Eti-Lot card

Please upload a clear photo of the Eti-Lot card, ensuring that the employee number is visible.

Example – Label Showing the Case Information

Example of the label showing the case information.

Upload a photo of the label showing the case information

Please upload a clear photo of the label ensuring that the case information is clearly visible.

Important: Please retain any product sample related to this complaint and do not discard it, whenever possible and safe to do so. A sample return may be required as part of our investigation.

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Customer Quality Complaint Form