On-line Complaints

Applicant Identification

				Name
	                            
				Company
	                            
				E-mail
	             
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				Adress
	                            
					Postcode
		                                
                    Extensão
					                    
					City
		            			                    
					Telephone
		            				                    
					Cell phone

Complaint Type

^* Description

Description of the Offender

Description of the Facts

Practice

Date

Economic Activity

^* Description

Attachment

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