Claim Book - Andean Moments

Provider: Andean Moments Peru E.I.R.L.

RUC: 20615685926

Address: Prolongación Tupac Amaru S/N, San Jerónimo, Cusco, Perú

Date *

1. Consumer identification

Full name * ID document (DNI / Foreigner ID / Passport) * Address * Phone number Email * Parent or legal guardian (if minor)

2. Contracted product or service

Type * Product Service

Claimed amount (PEN) If applicable. Description of the product or service *

3. Details of the claim/complaint and consumer request

Type of record * Claim — Disagreement related to products or services. Complaint — Disagreement not related to products or services, or dissatisfaction with customer service.

Details * Describe the facts that motivate your claim or complaint. Consumer request * Clearly indicate what you are requesting from the provider. I declare that the information given is true. * I authorize the processing of my personal data for the purpose of handling this claim/complaint, in accordance with data protection rules. *

* Filing a claim or complaint in this Complaints Book does not prevent you from using other dispute resolution mechanisms, nor is it a prerequisite to file a complaint before INDECOPI.

* We aim to respond to your claim or complaint within a maximum of three (3) working days.