Claim sheet example

When a service is provided or products are traded, it is inevitable to make mistakes that can affect consumers or users. This is why many countries have established as a rule that many businesses have a complaint form so that poorly served people can present their complaints.

What is a claim sheet?

Also known as a complaint book or a complaint book , this document can be in a format pre-established by the competent bodies or personalized, as in the case of independent professionals.

Public (government) institutions or educational entities are another group of organizations that are not obliged to offer a complaint form to users or members.

What are the claims sheets like and what do they contain?

This document has three sheets with a specific purpose: the first is for the user who will make the claim (s), the second is to be filled out by the body in charge of ensuring the welfare of consumers and the third will be a copy that will be kept in the company in question or service provider.

If there are other types of documents such as invoices or contracts that can be used for the complaint to have a favorable response for the user , they may be attached to the complaint file. After 15 days of the introduction of the complaint, a response should be obtained.

The purpose of the complaint forms is to serve as a support for government entities to call attention to companies or people who are incurring mistreatment towards their clients.

The complaint can only be rejected or it can take effect and the company must provide a solution, if not, the case could well be taken to more formal and judicial bodies.

The basic structure of a claim sheet is:

  • Basic data: identification information of the affected / claimant.
  • Description of the complaint, claim or complaint: Write clearly and precisely the reason for the annoyance.
  • Consumer request: What do you want to achieve with the complaint?
  • Documents attached: Any document that can complement the claim.
  • Observations of the establishment: Any other relevant comment about what happened.

Claim sheet example


Name and Surname: Sol Núñez

CI: V17897123

Address: Caracas

Phone: 0212xxxx

In case of representation:

Name and Surname of the person represented:

The representative does so in the capacity of:


Business name:







Data from the public registry of the entity:

Data of the person presenting the complaint or claim:

Name and surname:


Acts in the capacity of..


Name of the company: Establishment FarmaYA CA

Department: medical equipment


Describe the facts and reasons for the complaint or claim that you present to the company’s Customer Service: Surcharge for the sale of two products that marked a price on the shelf and another in the administrative cash system.

Describe the request you make to XXXXX in relation to the events described above:

A call for attention to the store to set prices according to the market….

I hereby declare that I am not aware that the subject matter of the complaint or claim is being substantiated through an administrative, arbitration or judicial procedure….

In Caracas on the 25th day of August 2010

Claimant’s signature.

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