Complaining Consumer Identification * required data

name *
First LastName *
Second LastName *
type of documentation *
documentation number *
CELPHONE *
department *
province *
district *
address *
reference
Email *

Are you a minor?
yes
Not

Detail of the Claim and Consumer Order * Required data

Claim type *
type of consumption *
Order no. *
Claim / Complaint Date
Provider
Reclaimed Amount (S/.)
Description of the product or service *
Date of Purchase
Date of consumption
expiration date
Detail of the Claim / Complaint, as indicated by the client: *
client order: *
(1) Claim: disagreement related to products and / or services.
(2) Complain:disagreement not related to products and / or services; or, dissatisfaction with the attention to the public.
I declare that I am the owner of the service and I accept the content of this form by stating under an affidavit the veracity of the facts described.
* The formulation of the claim does not preclude resorting 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 of no more than fiftteen (15) calendar days, being able to extend the period up to fifteen days.
* By signing this document, the client authorizes to be contacted after the claim has been dealing with in order to evaluate the quality and satisfaction with the claims service process.
I have read and accept the privacy and security policy and the cookies policy.