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Document Code:
FM-CSF-BN/Online_F2F-Assisted_01
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Version No.:
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Effectivity Date:
August 1, 2023
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DEPARTMENT OF TRADE AND INDUSTRY
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DTI-Digital Philippines*Business Name Registration Division
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CLIENT SATISFACTION FEEDBACK FORM
BUSINESS NAME REGISTRATION - Online
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CONSENT: I hereby consent to the collection and processing by the DTI of my name, contact details, and my feedback on its services for the purpose of monitoring, measuring, and analyzing customer feedback and of improving DTI services. I shall notify the DTI in case of any changes in my personal information. This consent shall be valid, unless revoked or withdrawn in writing subject to the applicable provisions of the Data Privacy Act of 2012 or Republic Act no. 10173.
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Client's Signature Date
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CLIENT'S NAME:
 (Title/ Prefix) (First Name) (Middle Initial) (Last Name) (Suffix)
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Client type: ☐ Citizen ☐ Business ☐ Government (Employee or another agency)
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Sex: ☐ Male ☐ Female Age: _______ Region of residence: ___________________________
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CONTACT NUMBER: E-MAIL ADDRESS:
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PART I. Check mark (✔ ) your answer to the Citizen’s Charter (CC) questions. The Citizen’s Charter is an official document that reflects the services of a government agency/office including its requirements, fees, and processing times among others.
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A.
Please check-mark the box that corresponds to your answer.
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CC1Which of the following best describes your awareness of a CC?
☐ 1. I know what a CC is and I saw this office’s CC.
☐ 2. I know what a CC is but I did NOT see this office’s CC.
☐ 3. I learned of the CC only when I saw this office’s CC.
☐ 4. I do not know what a CC is and I did not see one in this office. (Answer ‘N/A’ on CC2 and CC3)
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CC2If aware of CC (answered 1-3 in CC1), would you say that the CC of this office was …?
☐ 1. Easy to see ☐ 4. Not visible at all
☐ 2. Somewhat easy to see ☐ 5. N/A
☐ 3. Difficult to see
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CC3If aware of CC (answered codes 1-3 in CC1), how much did the CC help you in your transaction?
☐ 1. Helped very much ☐ 3. Did not help
☐ 2. Somewhat helped ☐ 4. N/A
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PART II. Our office is committed to continually improve our services to our external clients. Please answer this Form for us to know your feedback on the different aspects of our services. Your feedback and impressions will help us in improving our services in order to better serve our clients. Rest assured all information you will provide shall be treated with strict confidentiality.
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For each criterion below, please check-mark the box under the column pertaining to your answer. Mark ONE BOX ONLY for each row. For every "DISSATISFIED" or "VERY DISSATISFIED" rating you will give, please provide reason/s in PART III below.
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CRITERIA FOR RATINGRATING
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VERY
SATISFIED		SATISFIEDDISSATISFIEDVERY DISSATISFIED
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1.ACCESS AND FACILITIES
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a. Accessibility of the online system and its user interface (user-friendly/easy to navigate) ££££
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2.COMMUNICATION
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a. Availability of information about the transaction at the office or its website££££
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b. Notification of acceptance of submitted requirements££££
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3.RESPONSIVENESS
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a. Delivery of service within the prescribed time££££
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b. Delivery of accurate information££££
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4.RELIABILITY
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a. Provision of the needed service as expected after following the steps and requirements provided ££££
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c. Provision of an error-free transaction££££
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5.INTEGRITY
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a. Assurance that the transaction is free of unauthorized manipulation££££
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b. Assurance of privacy of user's personal information££££
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6.COST/S
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a. Payment Channel/Mode of Payment££££
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b. Amount paid for the transaction (value for money)££££
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7.ASSURANCE
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a. Assistance from the staff onsite (if asked for help)££££
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a. Assistance from HelpDesk/TechSupport (if any)££££
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8.OUTCOME (Result of service/s rendered)££££
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OVERALL SATISFACTION RATING
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Overall satisfaction with the service availed££££
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PART III. COMMENTS AND SUGGESTIONS
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Please write in the space below your reason/s for your "DISSATISFIED" or "VERY DISSATISFIED" rating so that we will know in which area/s we need to improve.
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Please give comments/suggestions to help us improve our service/s:
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THANK YOU!
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