DTI Complaint Form
DTI Complaint Form
DTI Complaint Form
3. NAME/S OF RESPONDENT/S:
6. CAUSE/S OF ACTION:
( / ) VIOLATION OF THE CONSUMER ACT OF THE PHILIPPINES
(R.A. 7394) , MORE PARTICULARLY:
( ) NARRATION:
On January 22nd, 2021, the respondent Mr. Richard V. San Juan representing
BlueCode E Information Technology Solutions signed a Motorshop Software Development
Agreement with Mr. Jose R. Jose (the complainant). The contract clearly states that Mr. Jose
is hiring BlueCode E Information Technology Solutions to develop and implement a software
program for a motorshop.
7. PROOFS/EVIDENCES (ATTACHED):
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
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8. RELIEF: COMPLAINANT/S PRAY FOR THE FOLLOWING:
(/ ) REFUND
( ) REPLACEMENT
( ) OTHERS:
____________________________________
____________________________________
____________________________________
_______________
COMPLAINANT
VERIFICATION/CERTIFICATION
_______________
COMPLAINANT
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SUBSCRIBED AND SWORN TO THIS ____ DAY OF ____________, AFFAINT/S
HAVING EXHIBITED TO ME HIS/HER/THEIR COMMUNITY TAX CERTIFICATE
NO. ________________ ISSUED ON ___________________ AT _______________ AND
HIS/HER/THEIR GOVERNMENT-ISSUED IDENTIFICATION CARD NO.
_______________________, AS FOLLOWS:
________________________
ADJUDICATION OFFICER
NCR-SF050
Rev00/2013
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