Online Investor Complaint Form

Before Filing This Complaint Form...

The Securities Division protects the general public against:

• fraud in the offer and sales of securities;
• unregistered or dishonest stock broker-dealers or investment advisory firms or their employees;
• unregistered or fraudulent securities.
  

For matterts outside our jurisdiction, the Secretary of the Commonwealth's Citizen's Information Service can refer you to the proper agencies which regulates these activities. Telephone 1-800-392-6090 (in Massachusetts only, TTY also) or 617-727-7030 ; email: cis@sec.state.ma.us.

If you believe you are a victim of fraud, please follow the instructions below:

Investor Complaint Form Instructions

• Please fill out the information as completely as possible. The information you file with the Enforcement Section must be true, complete and absolutely accurate. If you are not sure, you should not guess. You may write "unsure" or a similar response.
• Use your "Tab" key to move to the next field.
• When you have completed the form, click the "Submit Complaint Form" button at the bottom of this page. To delete all the information in the form, use the "Clear All Information" button.
• Important notice about Internet security... Electronic transmissions on the Internet are not always secure. You may decide to file only the basic information about your complaint to us using the Internet, and send confidential information by regular mail.

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Investor Complaint Form

Information About Yourself

Name:
E-mail Address:
Mailing Address:
City:
State:
Zip Code:
Work Phone:
Home Phone:

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Complaint Information

Describe your complaint. Provide details such as account number, names, dates, amounts, name of security, etc.

 Approximate time frame of the activities described above (e.g. from 12/23/2010 to 4/11):
From to

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Complaint Status

Have you complained to the firm/salesperson in writing?	yes	no
Have you filed a complaint with other securities regulators?	yes	no

If yes, which regulator(s)? (choose all that apply)

Securities and Exchange Commission

FINRA

other state regulators

stock exchanges or NASDAQ

law enforcement (name agency):

others (describe):

Have you filed an arbitration claim?	yes	no
Have you started formal legal action or retained an attorney to represent you?	yes	no

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  Denotes required field.

Important notice about Internet security...Electronic transmissions on the Internet are not always secure. You may decide to file only the basic information about your complaint to us using the Internet. If a Securities Division investigator requests that you send confidential information by regular mail, send it to:

William Francis Galvin
Secretary of the Commonwealth
Securities Division, Enforcement Section
One Ashburton Place, Room 1701
Boston, MA 02108

Thank you for your submission. We rely on citizens such as yourself to alert us to fraudulent activity. An investigator from the Enforcement Section will be contacting you after reviewing this complaint.

 (to start over or to not submit your complaint)