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ANNEX A

FORM No. ___


NOTICE OF LEMON LAW RIGHTS
To: Customer Relations Manager
Name of Dealership:
Address of Dealership:
Copy Furnished:
To: Customer Relations Manager
Name of Manufacturer/Distributor:
Address of Manufacturer/Distributor:
This constitutes a notice of my intention to invoke my rights under Republic Act No. 10642
entitled AN ACT STRENGTHENING CONSUMER PROTECTION IN THE PURCHASE
OF BRAND NEW MOTOR VEHICLES, considering that the manufacturer, distributor,
authorized dealer or retailer, after four (4) separate attempts, has been unable to resolve
the complaint indicated below.
Description of
Complaint

Repair
Attempts

Odometer
Reading

Date of Delivery
by Consumer for
Repair

Date of
Completion of
Repair

#1
#2
#3
#4
Vehicle Make: ____________________Model: _________________Year:________
Vehicle Identification Number: ___________________________________________
Name/Address of Selling Dealer:
________________________________________________________________________
__________________________________________________________________
Delivery Date: _______________Current Odometer Reading: ___________________
Repair
No.

Name and Address of Service/Repair Facility

Date of Repair

1
2
3
4
I am requesting that you make a final attempt to resolve the said complaint reported
above. My contact information is:
Name ______________________________Contact No.________________________
Address______________________________________________________________
Consumer signature _______________________Today's date __________________

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