A complaint cannot be processed by the CDVM unless an evidence of an initial complaint to the concerned firm or individual is provided.

Please read these important instructions before filling this form.

Part I: Details of the parties concerned by the complaint

1. Contact details

Title: - None -MrMrs

Surname: *

First Name: *

Name of the firm:

Adresse: *

Telephone number: *

E-mail :

Fax:

2. Details of the firm targetted in your complaint

Name of the firm: *

Firm address:

Other contact details (if available):

Name of the person processing your case:

3. Details of the person targetted in your complaint

Surname & First name: *

Company name: *

Occupation: *

Contact details (work):

PART II : Details of your complaint

1. About the Financial instrument/service targetted in the complaint

Instrument name: *

Service name: *

2. Brief details of your complaints: *

3. Brief details of steps you have taken to date in order to try and resolve the matter complained of: *

4. Have you taken any judicial process in order to resolve the matter of the complaint?: *

5. What is the expected result?: *

PART III : Required documents for the complaint’s treatment

You may wish to include copies of correspondance you wish to be considered as evidence with this form

File 1:

File 2:

File 3:

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