Complaint Appeal Register Identification No. (Unique) Dt. of Receipt Dt. Closed Type AppealDisputeComplaint Received From Organization : Customer (End user) : Interested Party : Others : Name : Phone No. : Email : Address : Organization on which this was reported : Phone No. : Email : Details: Reviewed by And Actions Initiated & Completed: Identified for any CA: Reviewed by And Actions Initiated & Completed: Referred to committee for resolution (if required): Initials of C.O.C : Dt. of Receipt