COMPLAINTS BOOK

1- Identification of the complaining consumer

Name:*

Surname:*

Second surname:*

Document type:*

Nº de Documento:*

Cell phone:*

Department:*

Province:*

District:*

Address:*

Reference:*

Mail:*

Are you underage?*YeahNo

2- Detail of the claim and consumer order

Claim Type:*

Type of consumption:*

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:*

3- Observations and actions taken by the provider

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.

COMPLAINTS BOOK

1- Identification of the complaining consumer

2- Detail of the claim and consumer order

3- Observations and actions taken by the provider

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