Complaint Initiator Information
Name
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Phone
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Email
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Customer Contact Information
Same as Complaint Initiator Information
Contact Person
Contact Person Phone
Contact Email
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Company Name
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Address
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Country
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AFGHANISTAN
ALAND ISLANDS
ALBANIA
ALGERIA
AMER.VIRGIN IS.
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA-HERZ.
BOTSWANA
BOUVET ISLANDS
BRAZIL
BRIT.IND.OC.TER
BRIT.VIRGIN IS.
BRUNEI DARUSS.
BULGARIA
BURKINA-FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFR.REP
CHAD
CHANNEL ISLANDS
CHILE
CHINA
CHRISTMAS ISLND
COCONUT ISLANDS
COLOMBIA
COMOROS
CONGO
CONGO BRAZZAVILLE
COOK ISLANDS
COSTA RICA
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DOMINICA
DOMINICAN REP.
DJIBOUTI
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FALKLAND ISLANDS (MALVINAS)
FAROE ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GLOBAL
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD AND MCDONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISLE OF MAN
ISRAEL
ITALY
IVORY COAST
JAMAICA
JAPAN
JERSEY
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA NORTH
KOSOVO
KUWAIT
KYRGYZSTAN
LAO PDR
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAO SAR CHINA
MACEDONIA REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA FEDERATED STATES OF
MOLDOVA
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OBSOLETE
OMAN
PACIFIC ISLAND
PAKISTAN
PALAU
PALESTINIAN TERRITORY
PANAMA
PAP. NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FED.
RWANDA
SAINT-BARTHELEMY
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT-MARTIN (FRENCH PART)
SAINT PIERRE AND MIQUELON
SAINT VINCENT AND GRENADINES
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SCOTLAND
SENEGAL
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SOUTH KOREA
SOUTH SUDAN
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD AND JAN MAYEN ISLANDS
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKSTAN
TANZANIA
THAILAND
TIMOR-LESTE
TOGO
TOKELAU
TONGA
TRINIDADTOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED KINGDOM
URUGUAY
USA
US MINOR OUTLYING ISLANDS
UTD.ARAB EMIR.
UZBEKISTAN
VANUATU
VENEZUELA
VIETNAM
VIRGIN ISLANDS US
WALLIS AND FUTUNA ISLANDS
WESTERN SAHARA
YEMEN
ZAMBIA
ZIMBABWE
Piramal Customer Number
City
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Zip Code
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Complaint Type
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Other
Product
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Product Name
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