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COMPLAINT

FORM
Date: Time:

BRANCH/SERVICE DATA

Name or trade name Tax code/number

Address: Street or square Localidad City

CUSTOMER DATA

Name and surname Foreign ID

Address Nº Number Floor Post Code Location

Contact phone/s

Reasons of the claimant:

Attached documents (invoice, ticket, sample, etc.):

Allegations of the defendant:

(Signature and stamp of the Defendant)

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