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Name*
Surname *
Second surname *
Documentation type *
---DNICEPassportRUC
Documentation number *
Cell phone*
Department*
---AMAZONASANCASHAPURIMACAREQUIPAAYACUCHOCAJAMARCACALLAOCUSCOHUANCAVELICAHUANUCOICAJUNINLA LIBERTADLAMBAYEQUELIMALORETOMADRE DE DIOSMOQUEGUAPASCOPIURAPUNOSAN MARTINTACNATUMBESUCAYALI
Province*
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District*
Address*
Reference
E-mail *
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Name
E-mail
Documentation type
Documentation number
Claim Type*
---ClaimComplain
Type of consumption *
---ProductService
Order number. *
Supplier*
Claimed amount (S/.)*
Date of claim / complaint*
Description of the product or service *
Date of purchase *
consumption date *
Date of Expiry*
Detail of the Claim / Complaint, as indicated by the client:*
Client's order: *
* The formulation of the claim does not exclude recourse 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 not exceeding thirty (30) calendar days, and may extend the period up to thirty days.
* By signing this document, the client authorizes to be contacted after the claim has been processed to assess the quality and satisfaction of the claims handling process.