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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 department
AMAZONAS
ANCASH
APURIMAC
AREQUIPA
AYACUCHO
CAJAMARCA
CALLAO
CUSCO
HUANCAVELICA
HUANUCO
ICA
JUNIN
LA LIBERTAD
LAMBAYEQUE
LIMA
LORETO
MADRE DE DIOS
MOQUEGUA
PASCO
PIURA
PUNO
SAN MARTIN
TACNA
TUMBES
UCAYALI
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Address
*
Reference
Email
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Are you a minor?
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Father / Mother / Tutor
Name
Email
Type of documentation
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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.
*
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