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.

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