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Complaint Ref. No:
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Date:
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Complaint title:
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Priority:
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Product Details
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Product:
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Product code:
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Batch no/Expiry:
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Date Sample Received:
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No. of Samples received
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Caller Details
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Title:
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First name:
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Surname
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Telephone:
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Street/PO Box:
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City:
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State:
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Post Code:
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Caller Profile:
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Send
the completed form to QA for further investigation
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Description
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Further comment
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