Customer Name and Address:

Please tick the appropriate block ('10' indicates highest level of satisfaction and '1' indicates lowest level of satisfaction).

A) QUALITY
(a) Meeting Specifications 10 9 8 7 6 5 4 3 2 1
(b) Consistency in Quality 10 9 8 7 6 5 4 3 2 1
(c) Appearance of the Product 10 9 8 7 6 5 4 3 2 1
(d) Identification and Labelling 10 9 8 7 6 5 4 3 2 1
(e) Packing 10 9 8 7 6 5 4 3 2 1

B) DELIVERY
(a) On time Delivery 10 9 8 7 6 5 4 3 2 1
Accommodate urgency /modification in delivery
(b) 10 9 8 7 6 5 4 3 2 1
schedules

C) PRICE
(a) Value for money 10 9 8 7 6 5 4 3 2 1

D) SERVICE
(a) Our response to your special requirements 10 9 8 7 6 5 4 3 2 1
(b) Our Product Range 10 9 8 7 6 5 4 3 2 1
(c) Time taken for developing your products 10 9 8 7 6 5 4 3 2 1
(d) Our response to your communication 10 9 8 7 6 5 4 3 2 1

Actual Weightage
Customer Satisfaction Index = X 100
Possible Weightage
=

GUIDANCE FOR ACTION

100-90 : Meets Expectation

89-80 : Acceptable but requires improvement
79-70 : Identify areas of improvements
<70 : Understand customer requirement properly

YOUR VALUABLE SUGGESTIONS FOR IMPROVEMENT (On specific issue, please)

Name: Signature:

Designation: Date:
Note: (i) If require, attach additional sheets

FF-BDM-06 Iss. 02 01-10-2011 Page 1 of 1