First Name:*
Last Name:*
Second Last Name:*
Document Type:*—Por favor, elige una opción—DNICERUCPassport
Document Number:*
Mobile Number:*
Department:*
Province:*
District:*
Address:*
Reference:
Email:*
Are you underage?*YesNo
Claim Type:*—Por favor, elige una opción—ClaimComplaint
Consumption Type:*—Por favor, elige una opción—ServiceProduct
Order Number:*
Claim Date:*
Purchase Date:*
Claim Amount S/:*
Description of the product or service:*
Details of the claim/complaint according to the customer:*
(1)Claim: Disagreement related to products and/or services.
(2)Complaint: Disagreement not related to products and/or services; or dissatisfaction with customer service.
Submitting this claim does not exclude the use of other dispute resolution methods nor is it a prerequisite for filing a complaint with Indecopi.
The provider must respond to the claim within a period not exceeding thirty (30) calendar days, which may be extended for an additional thirty days.
By signing this document, the customer authorizes being contacted after the complaint process to evaluate the quality and satisfaction of the claim handling process.
I accept the content of this form and the accuracy of the facts described under Sworn Statement.
* Required Fields.
