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Reference Number (other than GGRC)
For GGRC No. (Select Year)
--Select--
1112
1213
1314
1415
1516
1617
1718
1819
1920
2021
2122
2223
2324
Select District Code
--Select--
AMD
AMR
AND
ARV
BK
BHR
BTD
BVN
CTU
DBD
DH
DG
GN
GS
JMN
JND
KH
KCT
MRB
MS
MSN
NMD
NVS
PM
PTN
PBR
RJT
SK
SRT
SNR
TP
BRD
VLD
Fill Number
SBU
*
--Select--
West
Central
South
State
*
--Select--
District
*
--Select--
Taluka
Village
Farmer's Name
Farmer Contact No
*
Name of Dealer
SAP Code
Dealer Contact No
Category
*
--Select--
Product Related
Material Supply Logistics
Survey_Design
Installation
Enquiry Handling
After Sales Service
Price
Agronomy
Accounts
Other
Sub-Category
*
--Select--
Specific Product/category
*
--Select--
Describe Complaint in Detail
*
Product Description
Size
Cat. No.
Sales Order No
*
SO Date
*
Faulty Product Description
Size
Faulty Product Cat. No.
*
Date of Installation
*
Date of Trial
*
Total Quantity Supplied
Problematic Quantity
Delivery Note No
Delivery Date
Sample Sent?
No
Yes
Shipment No
*
Shipment Detail
Type of installation
--Select--
Surface
Sub-Surface
Image / Photograph / Picture
Image / Photograph / Picture
Image / Photograph / Picture
Challan Copy / LR / Other Document/Invoice
*
Challan Copy / LR / Other Document
Challan Copy / LR / Other Document
Shipping Receipt Photo
*
Others [Not Mentioned Above]
Others [Not Mentioned Above]
Your Recommendation
Other Remarks
Your Name
*
Your Email
*
Mobile
*
Date