Name of the Company*
Name of the Person*
Address*
State* -- Select State --Andaman and Nicobar IslandsAndhra PradeshArunachal PradeshAssamBiharChandigarhChhattisgarhDelhiGoaGujaratHaryanaHimachal PradeshJammu and KashmirJharkhandKarnatakaKeralaLadakhLakshadweepMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherryPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest Bengal
Mobile No.*
Your Email*
Nature of Complaint* -- Complaint Nature --IndividualCompanySubsidiary CompanyFirmCorporationGroup
Types of Complaints* -- Complaint Type --False or Misleading claimsTextual and audio-visual promotions not consistent with the codeUnethical gifts, benefits and hospitalityConduct of Conference/CME/Seminars/Research non consistent with the codeSample distribution not consistent with the codeAny other violations
Complaint Details*
Attachment
GST No.*
Payment of Non-refundable amount
Pay with
Payment Transaction Details (Auto-fill After Payment Success)
Δ