Product FeedbackDate Product InformationProduct Name (Please provide full description as specified on label including Brand Name) Weight/Volume Date Coding (SB, UB/BB, Batch Code) Company Name & Address Purchased From Province Gauteng Northern Cape Eastern Cape Western Cape Free State KZN Mpumalanga North West Limpopo Local Government Nature of ComplaintDetailed description Complaint TypeSuspected Food Poisoning (Possible Symptoms: Nausea and / or Vomiting and / or Diarrhea after a certain period of time once food is ingested) YesPlease Elaborate Foreign Object/s Please Elaborate Organoleptic Taste Smell Appearance OtherPlease Elaborate Packaging Not sealed properly No label evident No date coding available OtherPlease Elaborate Consumer Fraud Underfilled Watery OtherPlease Elaborate Complainant DetailsTitle Initials Name Surname Contact Number Email CommentsWould you prefer to remain anonymous No YesAdditional Comments Captcha Powered by ChronoForms - ChronoEngine.com
