Claims book

Full name

Mail

Type of ID Type of IDDNIRUCECOther

ID number (IID, RUC, etc.)

Telephone / Cell

Date of claim

Address

Detail of the claim Detail of the claim Claim Complaints

Well hired Well hired Product Service

Detail of the claim

Actions taken by the supplier

Jury declaration Jury declaration I declare to be the service holder and accept the content of this form by expressing under the Declaration of Jury the veracity of the facts described. Robles Ibazeta Consultores reserves the right to take the relevant legal actions in the event that the inaccuracy of the statements previously made is verified.