Dangerous Product Notification Form
Producer’s name :
(Company, Trademark, other):
*
Address / Postcode:
*
Email :
*
Fax :
Telephone:
Name of dangerous product::
*
Product Batch:
*
Briefly describe the danger that the product may cause:
*
Information leading to the detection of the product (Point of sale, code/model, country of origin, other):
Actions taken by the producer:
*
Consumer Fullname:
*
Consumer Email Address:
*
Consumer Telephone Number:
Consumer District:
*
Please attach a photo of the product, if available (file should not exceed 4Mb):
*
Type in the letters and/or numbers you see on the left:
1. After submitting, you will see a confirmation note.
2.
*
Required fields.
I have read and agree
with the
data protection privacy statement