DTI Complaint Form

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COMPLAINT

THE UNDERSIGNED COMPLAINANT/S TO THIS HONORABLE OFFICE, MOST


RESPECTFULLY ALLEGE/S THAT:

1. NAME/S OF COMPLAINANT/S: AGE STATUS

Name:____JOSE REYES JOSE________ _50____ ________


_________________________________ _______ ________
Tel No:____0286391253_______ _______ ________
_________________________________ _______ ________
Email Add:___jjose1208@yahoo.com_ _______ ________
_________________________________ _______ ________

2. ADDRESS: 5 Dona Juana St Potrero Malabon City, Metro Manila, Philippines

3. NAME/S OF RESPONDENT/S:

Company Name:__BlueCode E Information Technology Solutions


Tel No:_0927 505 9059
Email Add: rsanjuan@bluecode.com.ph

4. ADDRESS: Salcedo Village, 7F Finman Building, 131 Tordesillas, Makati, 1227


Metro Manila

5. OWNER/MANAGER: Richard V. San Juan

6. CAUSE/S OF ACTION:
( / ) VIOLATION OF THE CONSUMER ACT OF THE PHILIPPINES
(R.A. 7394) , MORE PARTICULARLY:

( ) PROVISIONS ON CONSUMER PRODUCT QUALITY &


SAFETY
(/) PROVISION ON DECEPTIVE, UNFAIR AND
UNCONSCIONABLE ACTS/PRACTICES
( ) PROVISIONS ON CONSUMER PRODUCT AND SERVICE
WARRANTIES
( ) PROVISIONS ON LABELING AND FAIR PACKAGING
( /) PROVISIONS ON DEFECTIVE PRODUCTS AND SERVICE
IMPERFECTION
( ) PROVISIONS ON ADVERTISING AND SALES PROMOTION
( ) CHAIN DISTRIBUTION PLANS OR PYRAMID SALES SCHEMES
( ) OTHER PROVISIONS CONTAINED THEREIN,
SECIFICALLY:
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__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
( ) VIOLATION OF PHILIPPINE LEMON LAW (RA 10642 )
( ) VIOLATION OF THE BUSINESS NAME LAW
( ) VIOLATION OF THE LAW REGULATING THE BROKERAGE
BUSINESS
( ) VIOLATION OF R.A. NO. 71, AS AMENDED
(PRICE TAG LAW)
( ) OTHER FAIR TRADE LAWS
SPECIFY: _________________________________________
_________________________________________
_________________________________________
_________________________________________
AND/OR

( ) 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.

In signing, BlueCode E Information Technology Solutions agreed to design, develop and


COMPLETE the software program for Mr. Jose within six(6) months. Mr. Jose on the other
hand agreed to remunerate their company with a total of one hundred and twenty-five
thousand pesos (PHP 125,000), with an upfront payment of twenty-nine thousand pesos (PHP
29,000), and the balance of ninety-six thousand pesos PHP 96,000 shall be paid within six (6)
months as long as they they are able to execute their obligations as specified in the contract.

Unfortunately, BlueCode E Information Technology Solutions has failed to comply and


perform within the terms of the agreement amounting to a break of contract. This has
compelled Mr. Jose to demand a return and refund of the amount that has been paid to
BlueCode E Information Technology Solutions because they failed to produce a functioning
product within the time frame specified in the agreement.

7. PROOFS/EVIDENCES (ATTACHED):

______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________

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8. RELIEF: COMPLAINANT/S PRAY FOR THE FOLLOWING:

(/ ) REFUND
( ) REPLACEMENT
( ) OTHERS:
____________________________________
____________________________________
____________________________________

IN WITNESS WHEREOF, I HAVE HERUNTO SET MY HAND THIS ____ DAY


OF ___________________, 200___, IN _______________________________.

_______________
COMPLAINANT

VERIFICATION/CERTIFICATION

THE COMPLAINANT/S, UNDER OATH, HEREBY DEPOSE/S AND SAY/S:

A) THAT HE/SHE/THEY IS/ARE THE COMPLAINANT/S IN THE


INSTANT CASE:
B) THAT HE/SHE/THEY HAS/HAVE READ AND UNDERSTOOD THE
CONTENTS THEREOF:
C) THAT THE ALLEGATIONS THEREIN ARE TRUE AND CORRECT
OF HIS/HER/THEIR OWN PERSONAL KNOWLEDGE AND BELIEF
D) THAT FURTHER HE/SHE/THEY CERTIFY THAT AS OF THIS DATE,
HE/SHE/THEY HAS/HAVE NOT FILED IN ANY COURT, TRIBUNAL,
OR QUASI-JUDICIAL AGENCY, OTHER ACTION/S OR CLAIMS
INVOLVING THE SAME PARTIES AND THE SAME ISSUES. SHOULD
HE/SHE/THEY FIND/S THEREAFTER THAT A SIMILAR ACTION OR
CLAIM IS FILED OR PENDING IN ANY OTHER COURT, TRIBUNAL,
OR QUASI-JUDICIAL AGENCY, HE/SHE/THEY SHALL REPORT THE
SAME WITHIN FIVE (5) DAYS THEREFROM TO THIS HONORABLE
OFFICE.

_______________
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:

NAME CTC DETAILS. I.D. DETAILS

_________________________ ____________________ __________________


_________________________ ____________________ __________________
_________________________ ____________________ __________________
_________________________ ____________________ __________________
_________________________ ____________________ __________________
_________________________ ____________________ __________________

________________________
ADJUDICATION OFFICER

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