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Submit a Compliant

Complainant Information
* Family Name: 
* Name: 
Title: 
Street: 
Zip Code: 
City: 
Country: 
Phone: 
* E-mail: 
   
Company Information
Fill this if the trial is to be submited by Company
* Company/Organization: 
* IDN: 
* Address: 
Phone: 
   
Information about the commercial:
* Product title: 
Manufacturer: 
Manufacturer's Address: 
Media where the commercial is shown: 
   
Details:
* Complaint: 
* Motive: 
Other Actions Taken: 
Files:
File 1: 
File 2: