• Vacancy - Dossier Assessor & Systems Administrator
  07 June 2022
• |
• Provision of GMP Inspection Capacity Development Consultancy
  18 May 2022
• |
• List of Exempted Devices and Suppliers 03-2022
  09 March 2022
• |
• Listing of Cosmetics Listing
  02 March 2022
• |
• List of Exempted Devices and Supplier 01 -02-2022
  01 February 2022
• |
• BoMRA Medical Devices stakeholder engagement notice
  28 September 2021
• |

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Quality Complaints Form

From (in full with addresses)*

Enter where it is From (in full with addresses)

To:(see list attached , if more than one)*

Enter where it is to:(see list attached , if more than one)

Recall Number as Assigned: (where applicable)

Product; Brand/Trade Name*

Enter Product; Brand/Trade Name

INN or Generic Name*

Enter INN or Generic Name

Batch Number (and bulk, if different)*

Enter Batch Number

Strength*

Enter Strength

Pack Size and Presentation*

Enter Pack Size and Presentation

Expiry Date*

Provide expiry date

Date Manufactured*

Provide Date Manufactured

Dosage Form*

Provide Dosage form

Marketing Authorization Holder and addresses*

Enter Marketing Authorization Holder and addresses

Manufacturer and Addresses*

Enter Manufacturer and Addresses

Details of Defect (free text)*

Enter Details of Defect

Product Photo - Clear visible Photo of the product with clear II. labelling , III. Product name Stated manufacturer, IV. Batch number, V. Manufacturing date, VI. Expiry date, VII. Place of identification*

provide Product Photo

State Information On Distribution Including Exports (specify type of customer, e.g. hospitals)*

Enter State Information On Distribution Including Exports (specify type of customer, e.g. hospitals)

Reporter*

Enter Reporter

Reporter Facility*

Enter Reporter Facility

Reporter Telephone*

Enter Reporter Telephone

Reporter Cell Phone Number*

Enter Reporter Cell Phone Number

Reporter Physical Address*

Enter Reporter Physical Address

Reporter Postal Address*

Enter Reporter Postal Address

Reporter Signature - Use Full Names*

Enter Reporter Signature - Use Full Names

Date*

Provide date

FOR BoMRA OFFICE

Reference Number: FOR BOMRA USE

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*

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Cosmetics Stakeholder Form