Falsified product report form - IMAGE Information Systems

Falsified Product Report

Device Information

For which device(s)/device component(s) do you want to report a non-conformity?

Information on false presentation

What kind of false presentation did you observe?

Falsified device identity/identification (e.g. name, version, UDI) Falsified source (e.g. removed or altered manufacturer details) Falsified CE certificates Falsified documents relating to CE marking procedures Other

File Upload (optional)

Your contact data for feedback

First Name

Last Name

Telephone

E-Mail

Company/Institution

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