Standard Claim Form:
To: ........................................................................................
I/we hereby notify that I/we have discovered the non-compliance of the services quality with the agreement.
The subject of the claim is as follows below:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Sent/Received – …………………………………
Your preferred way to resolve the claim (encircle as applicable):
- Perform the service in accordance with the agreement.
- Decrease the price.
- Refund the amount paid.
I am attaching the following documents hereto (encircle as applicable):
- the check or invoice;
- reports, certificates or other documents, which confirm the non-compliance of the quality of the product or the service provided with the agreement reached;
- other documents, which confirm the claim in terms of the grounds and amount.
The amount that I/we wish to apply for is as follows: …………………………………………………………………
The consumer's name/consumers' names: …………………………………………………………………
The consumer's address/consumers' addresses: …………………………………………………………………
The consumer's signature (only when filing a paper claim):
…………………………………………………………………
Date: …………………………………
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