Name:*
Surname:*
Second surname:*
Document type:*—Por favor, elige una opción—DNICERUCPassport
Nº de Documento:*
Cell phone:*
Department:*
Province:*
District:*
Address:*
Reference:*
Mail:*
Are you underage?*YeahNo
Claim Type:*—Por favor, elige una opción—ReclamoQueja
Type of consumption:*—Por favor, elige una opción—ServicioProducto
order number:*
Claim date:*
Supplier:*
claim amount S/:*
Description of the product or service:*
Date of purchase:*
Consumption date:*
Date of Expiry:*
Claim/complaint detail, as indicated by the client:*
Date of communication of the response:
Detail:THIS FIELD WILL BE FILLED IN BY THE SUPPLIER WHEN ADDRESSING YOUR COMPLAINT OR CLAIM
(1)Claim: Disagreement related to products and/or services.
(2)Complaint: Disagreement not related to products and/or services; or discomfort or dissatisfaction with customer service.
* The formulation of the claim does not exclude recourse to other means of dispute resolution nor is it a prerequisite for filing a complaint with Indecopi.
* The provider must respond to the claim within a period not exceeding thirty (30) calendar days, and may extend the period up to thirty days.
* By signing this document, the customer authorizes to be contacted after the claim has been processed to assess the quality and satisfaction of the claim handling process.
* I declare that I am the owner of the business/company and I accept the content of this form and the veracity of the facts described under Affidavit.
