Consumer Protection Committee, Exective Yuan

Applicant’s Basic Information

Required

Processing Agency：
Name：
Date of Birth：
Mobile Phone：
Phone：
E-Mail：
Residential address：
Nationality：

Agent / representative

(If the complainant is under the age of 18, of if he/she does not appeal in person, please fill in the information of the agent.)

Name：
E-Mail：
Mobile Phone：
Phone：
Residential address：
Representative type：

Basic information on business operator

Required

Name：
Address：
Person in charge：
Phone：

Complaint Content

The Complaint in Brief：(limited in 800 words)
Essential and relevant details (e.g., relationship between consumer and business operator, time and place of incident, good or service being purchased, price, payment method, etc.)： How the complaint has been handled thus far (e.g., how the business operator responded or handled the matter, whether the matter has already been referred to a consumer protection group or Consumer Service Center)： Reason for the complaint (crux of the dispute)： Content of request：
Attachment：

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Attachment(s): Uploaded 0KB file(s), Size: 40960KB
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Set Event Password：

Your event password should be at least 8 characters and include at least 3 of the following: numbers, uppercase letters, lowercase letters, and special symbols(!@#$).

As part of the procedure for handling consumer disputes, this information will be provided to the business operator, so that the business operator will also know the reason for the complaint and what is being requested and respond accordingly; it will smooth out the process for the responsible authority involved. Please review the following items and choose at least two contact infomation you agree to provide to the business operator:

1. Telephone number
2. Mobile phone number
3. E-mail address
4. Residential address

(To prevent your rights and interests from being affected, please provide at least two ways for the business operator to contact you quickly and effectively.)