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Claim Sheet


DATE: Thursday, April 25, 2019

L.C. BUSRE S.A.C - RUC: 20131300353
Av. Pablo Carriquiry 857 San Isidro - Lima
1. Identification of the Claimant Consumer:
Last Name(*)
Mother’s Maiden Name
Name(*)
Address(1)
Country
Doc. Type
Doc. No.(*)(1)
E-Mail (*)(1)
Phone(1)
Father or Mother
If you are a minor

(1) These consigned spaces will contain the information of the father, mother or guardian for the cases of minors
(*) Required fields
2. Identification of the Contracted Goods:
City of Claim / Complaint(*)
City of Destination(*)
Type of Service
Reason for Claim
Book Code
Date of Flight (*)
Flight No.
Amount Claimed:
3. Detail of the claim
Type of Claim (*)
Claim
Disagreement related to products or services
Complaint
Disagreement unrelated to goods or services; discomfort or dissatisfaction with the customer service
Claim Detail (*)
Concrete Order
Add File