Doc Control No.

: FM-CC - Form 1 Rev 0

INITIAL COMPLAINT FORM

COMPLAINANT
Mr. Saul Rhys Corcurea Roberts
Name:
(Title/ Prefix) (First Name) (Middle Name) (Last Name) (Suffix)
Address House 1, 3rd Street, Felina Village Barangay Tisa

:
(House/Building No./Building Name) (Street Name) (Barangay)
Cebu City Cebu Region 7 6000
(City/Municipality) (Province) (Region) (Zip Code)
E-mail: saulrhyz@gmail.com Tel/Cel #: 09177101681
Social Classification:  Senior Citizen  Youth (15-30)  Out of School Youth Sex:  Male  Female
 Abled  Differently Abled  Indigenous Person
RESPONDENT
Name of Establishment: PLDT
Name of Owner/
Representative: (Title/ Prefix) (First Name) (Middle Name) (Last Name) (Suffix)
Address of Establishment: PLDT SM Seaside Store
(House/Building No./Building Name) (Street Name) (Barangay)

(City/Municipality) (Province) (Region) (Zip Code)

E-mail: care@pldt.ph Tel/Cel #:

Date of Consumer Transaction/Discovery: ______July 2022___________________________________________

Brief Narration of Facts:

_________________I applied for a plan 2399 that included a subsidized payment for 3 mesh devices. It has now
been 4 months since I opened the account and they have not delivered my mesh devices or advised me to pick it
up anywhere. They just keep saying they will follow up.
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Documents Submitted: _________Screenshot of account

_______________________________________________________________
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Relief Demanded:  Repair  Replace  Refund
 Others ____Devices, refund for periods I was not able to fully use my internet,
compensation for damages as we explicitly applied for the mesh because a lot of our family
member rely on it for work from home.
_______________________________________________________

IN WITNESS WHEREOF, I have hereunto set my/our hand/s this 4th day of August 20 22 , in
, Philippines.

___Saul Rhys C. Roberts___________________

Complainant

DTI Privacy Notice:

 Doc Control No. : FM-CC - Form 1 Rev 0

By escalating your concern to the DTI, you agree that this Office will collect your personal information such as name, address,
contact number, email, etc. The information will be shared with the establishment/s being complained of and other government
agencies for their appropriate action and possible resolution of your concern. The DTI is committed to ensuring the privacy and
security of all data collected, consistent with the Data Privacy Act of 2012, until the resolution of your concern. Data collected
will be used for purposes of our Consumer Complaints Handling Mechanism and in the performance of our mandate. For any
concerns on the use of your data, you may contact the Lead Data Protection Officer of the DTI through dpo@dti.gov.ph.

_____________Saul Rhys C. Roberts ______________________

(Signature over Printed Name of Authorized Signatory)