Complaints book

Identification of the complaining consumer

Natural person Company

First name*

Last names*

Cell phone*

Another phone

Document type*

Document number*

Type of address*

Address*

No/Lot*

Dept./Int.

Department*

Provincia

Distrito

Email*

Younger?

Identification of the contracted good

Product Service

Description*

Place, date and time of occurrence*

Detail of the Claim or Complaint

Complaint Disagreement related to products and/or services.

Complaint Dissatisfaction not related to the products and/or services, such as discomfort or dissatisfaction with customer service.

Detail*

Actions Taken by the Provider

Detail*

* Required fields are marked with an asterisk next to the field label.