SME
DBU
IBU
Cleaning Chemicals Cleaning Supplies CCF No:
CUSTOMER COMPLAINT FORM
DATE OF COMPLAINT NAME OF PRODUCT
CUSTOMER NAME BATCH NUMBER
AFFECTED QUANTITY
ADDRESS
DATE PURCHASED
CONTACT NUMBERS SALES INVOICE NO.
EMAIL ADDRESS VALUE OF INVOICE
VALUE OF COMPLAINED
CONTACT PERSON
PRODUCT
DESCRIPTION OF THE COMPLAINT: (attach a picture and provide sample for testing if applicable)
INVESTIGATION/EVALUATION (To be filled up by the concerned departments):
Discuss the nature of the complaint and what system/process failed
PARAMETERS FINDINGS/OBSERVATIONS ASSESSED BY
Retained Sample
Extensive Sample
Other Client Sample
Stability Result
RM/PM Quality
Manufacturing Process
QC Results
FG Warehouse
Delivery
CORRECTION
ACTION PLAN RESPONSIBILITY DATE ACCOMPLISHED
CORRECTIVE ACTION
ACTION PLAN RESPONSIBILITY DATE ACCOMPLISHED
Reported by: Reviewed by: Approved by:
Cyndi A. Calivara Jacquelyn I. Velasco Jason D. Matias
QC Head OIC DirectorCyndi
for QM and PPD
A. Calivara AVP for Operations
QC Head-OIC
Cyndi A. Calivara
QC Head-
OIC
SF-QAD-11
Page No. 1 of 1