IPI&D | Report Counterfeit

Report Counterfeit
If you would like to report fake, please fill out this form

* marks fields are mandatory

1. NAME OR DESCRIPTION OF COUNTERFEIT PRODUCT *

* Counterfeit Product Brand Name:

* Counterfeit Product Company/Manufacturer Name:

Found/Purchased the product - what/where/when:

Price:

Who is the seller/producer/importer/exporter etc. of the infringing product:

Any additional information:

Picture of the product/brand:

Maximum file size is 2 MB

2. LOCATION WHERE SEEN *
Please give us much information as possible

* Shops/Outlets Name:

* Address:

* City:

* State:

* Postal Code:

* Country:

* Date Seen:

3. INTERNET FINDING
If you found the counterfeit product(s) online, fill in the address of the website.

Website Address:

Website page snapshot:

Maximum file size is 2 MB

4. PERSONAL INFORMATION
Providing your personal information is optional and confidentially assured.

First Name:

Last Name:

Address:

City:

State:

Country:

Email Address:

5. COMMENTS
Please add any additional comments you feel are relevant.

Comments: