Consumereklamo

Republic of the Philippines
DEPARTMENT OF TRADE AND INDUSTRY
Camarines Norte Provincial Office
Merchant Avenue, Central Plaza Complex,
Lag-on, Daet, Camarines Norte

CONSUMER COMPLAINT

Complainant

Name:

Title/Prefix, First Name

Middle Name

Last Name

Suffix

Address:

Region

Province

City/Municipality

Zip Code

House/Bldg No./Bldg Name

Street Name

Barangay

Email:

Tel / Cell #:

Social Classification:

Sr. Citizen Youth Out of School Youth Abled
Differently Abled / With Disability Indigenous Person

Sex:

Male Female

Respondent

Name:

Establishment Name

Title/Prefix, First Name

Middle Name

Last Name

Suffix

Address:

Region

Province

City/Municipality

Zip Code

House/Bldg No./Bldg Name

Street Name

Barangay

Email:

Tel / Cell #:

Date of Consumer Transaction / Discovery:

Brief Narration of Facts:

Documents Submitted / Attached:

* You can only attach MS Word files and images up to 5MB.

Relief Demanded:

Repair Replace Refund

Others

IN WITNESS WHEREOF, I have hereunto set my/our hand/s this day of , in Daet, Camarines Norte, Philippines.

Complainant Signature

VERIFICATION AND CERTIFICATION

I, , Filipino, of legal age, single/married/widowed and a resident of , after having been duly sworn to in accordance with law, do hereby depose and say, that:

1. I am the Complainant in this case;

2. I have prepared and/or caused the preparation of the foregoing Complaint;

3. I have read the same, and the truth of which are true and correct of my own knowledge;

4. I hereby certify that I have not commenced any other action or proceeding involving the same issues in any court or other tribunal or quasi-judicial agency, and to the best of my knowledge no such other action or proceeding is pending in any of the aforesaid bodies, tribunal or agency, and if there is any similar action or proceeding filed or pending, that I should learn, in the future, that I shall report and inform this office of the matter immediately.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature this day of , 2024 at Daet, Camarines Norte.

Affiant Signature

I certify that I am at least 18 years old and of lawful age, and I have read and accept the Data Privacy Policy and Consent.