IC3 Complaint Referral Form
gob mx
PROCURADURIA FEDERAL DEL CONSUMIDOR
COMPLAINT RECEPTION FORMAT
(All FIELDS ARE REQUIRED)
DATE OF REQUEST
RECEIVING OFFICE
IMPORTANT
- An internal statement that governs an organization or entity’s handling practices of personal information. It is directed at the users of the personal information. A privacy policy instructs employees on the collection and the use of the data, as well as any specific rights the data subjects may have..
CONSUMER
NAME
LAST NAME
MALE
FEMALE
GENDER
AGE
ADDRESS (STREET, NUMBER, CITY)
COUNTRY
ZIP CODE
EMAIL
PHONE
DATE OF ACQUISITION SERVICE
SUPPLIER
SUPPLIER'S NAME
PHONE
SUPPLIER'S ADDRESS(STREET, NUMBER, CITY)
COUNTRY
ZIP CODE
CLAIM AMOUNT
REASON FOR THE CLAIM (DESCRIBE THE FACTS)
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