Step 1 of 2 50% Please note: This complaints form is only relevant to Complementary Medicines. If you submit a complaint relating to a product that is not a Complementary Medicine or that is not regulated by the SAHPRA, we will endeavour to forward the complaint to the appropriate unit / agency. However, this may not be guaranteed and may result in a delay in your complaint being considered. Should you wish to notify the SAHPRA of any adverse event or unwanted occurrence as a result of taking a Complementary Medicine please refer to the adverse events reporting form here.1. Your personal detailsSelect the category which best describes you:*AcademiaCompany/BusinessConsumerConsumer Organisation/BodyGovernment/Statutory BodyHealth care providerJournalist/PublisherRegulatory/Legal ConsultantDo you wish to remain anonymous?*Note: While the right to anonymity is supported, SAHPRA may not be able to clarify any item or follow up with you in respect of your complaint. Yes No NameRecommended field: to enable any additional feedback or contact. First Last Company NameIf you represent a company. Preferred means of contactPlease select the contact details you would like to submit that may enable SAHPRA to contact you for any matter related to your complaint. Email address Phone number Postal address Email* Enter Email Confirm Email Phone*Postal Address* Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Do you have any communication or language needs?Please advise if you have any communication or language needs we need to be aware of if we contact you about your complaint, or if you are making this complaint on behalf of somebody else. Yes No Communication or language needsPlease detail any communication or language needs we need to be aware of. 2. Details of your complaintWhat is the nature of your complaint?*Advertisement of productNon-compliance of productOtherAdvertisment Details*Complaints should be limited to single advertisement events. Complainants are asked to limit this complaint to one product only, unless the advertisement in question related to more than one product (maximum 5).Date and Time of AdvertMedia ForumMedia NameProduct NameName of manufacturer / company Describe the nature of your advertisement complaint*Provide sufficient detail / explanation for the complaint.Detail of non-compliance*Describe in detail the nature of the non-compliance (product name, compliance failures, ingredient listing and content, labelling). e.g. PRODUCT X was procured on DATE from RETAILER NAME and does not have a DISCLAIMER printed on the label as would be required of unregistered Complementary medicines.Other complaint*Describe in detail the nature of the complaint (product name, ingredient listing and content). Provide as much detail as possible. e.g. PRODUCT X was procured on DATE from RETAILER NAME and does not have ingredients that warrant its classification as a complementary medicine and pose a risk to the health of consumers.Upload FileYou may upload any image or evidence of the complaint. This must be in PDF, PNG or JPEG format and not more than 2 MB in size per file. Size limit of all documents may not exceed 6 MB. Wherever possible, please upload a copy of the advertisement (or any documentation supporting your complaint). Please note: This form will only allow upload of a maximum number of 3 files. Drop files here or Select files Accepted file types: pdf, jpeg, jpg, png, Max. file size: 6 MB, Max. files: 3. Warning: Zip files are not accepted. For any files that are more than 6 MB or if you would like to provide a zip file for this submission, please tell us in the description field above to enable us to arrange for alternative submission methods. All contact details must be provided for this service.ConsentI agree that the submission of my contact details will only be used for the purpose intended. I understand that my details will not be used for other purposes but that I may be contacted directly for any purpose connected with this complaint. I agree to the privacy policy.ReferenceCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
