Complaints Book

Registration No. — Date —

Definitions: Complaint = any dissatisfaction related to a product or service; Claim = any dissatisfaction regarding customer service or attention received.

1) Business Information

Company Name

Tax Identification Number (RUC/NIT)

Registered Address

2) Consumer Information

Full Name *

ID Number *

Minor

Legal Representative (if under 18)

Email Address *

Phone Number *

Department / Region *

Province *

District *

Address

3) Product or Service

Type *

Product Service

Claim Amount (S/) *

Receipt / Order Number

Purchase Date

Service Area or Customer Service Channel

Employee Who Provided Assistance (Optional)

Description of the Product or Service

4) Complaint or Claim

Type *

Complaint Claim

Response Method *

Email Physical

Complaint/Claim Details *

Consumer Request *

5) Authorizations

I authorize the use of my personal data for the handling of this complaint/claim, in accordance with applicable regulations. I declare that the information provided is true. *

6) Signature (Optional)

Sign with your mouse or finger (on mobile). Optional.

Registration Receipt