Sample Report Form

A sample report form can be used whenever one has come across counterfeit products which may cause harm to consumers and needs to report them. It is always advisable to put forward a report of such products to the relevant authorities. This form will therefore help to note down specific details about that particular product. Shown below is a sample report form.

Sample Report Form

Product __________________

Stage of supply _______________________

Source of supply ______________________

Brand name __________________________

Package size _________________________
Batch number ________________________

Expiry Date ___________________________

Reason why product is suspected to be counterfeit

________________________________________________________________________

How was the product detected?

________________________________________________________________________

Alert released by government or industry authorities

________________________________________________________________________________________________________________________________________________

Measures taken to prevent possible harm

________________________________________________________________________________________________________________________________________________

Most likely source of counterfeit product

________________________________________________________________________________________________________________________________________________

Most likely origin of counterfeit product

________________________________________________________________________________________________________________________________________________

Name of retailer ___________________________

Phone number ____________________________

Name of retail outlet _______________________

Street ___________________________________

City ____________________________________

Postal code _______________________________

Category: Report Forms