Claims Book Complaining Consumer Identification * Required data Name * First Lastname * Second Lastname * Type of documentation * Select of documentation DNI CE Passport RUC Documentation number * Celphone * Department * Select of departmentAMAZONASANCASHAPURIMACAREQUIPAAYACUCHOCAJAMARCACALLAOCUSCOHUANCAVELICAHUANUCOICAJUNINLA LIBERTADLAMBAYEQUELIMALORETOMADRE DE DIOSMOQUEGUAPASCOPIURAPUNOSAN MARTINTACNATUMBESUCAYALI Province * Select of province District * Select of district Address * Reference Email * Are you a minor? Yes No Father / Mother / Tutor Name Email Type of documentation Select of documetation DNI CE Passport RUC Number of document Detail of the Claim and Consumer Order * Required data Claim Type * Claim Type Claim (1) Complain(2) Type of consumption * Type of consumption Product Service 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, discomfort 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 fifteen (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 dealt 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.
