Report no.

:
Customer complaint form
Report date:

Customer Information

Customer name Customer PO no.

Contact person name Customer PO date

Customer contact no. S.O. no.

Customer address

Product Information

Product name Invoice no.

Product description

Complaint Information

Complaint details

Cause

Corrective action

Preventive action

Form no.: F-IS-05 Form rev. no.: 01 Rev./Rel. date: 15-Dec-2019 Page 1 of 1