Before filing this complaint form...

The Securities Division protects the general public against:

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

For matters outside our jurisdiction, the Secretary of the Commonwealth's Citizen Information Service can refer you to the proper agencies which regulate other activities:

• Telephone: 1-800-392-6090 (Massachusetts only, TTY also), or 617-727-7030
• E-mail: cis@sec.state.ma.us
  

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

Investor complaint form instructions

• 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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Information about the complaint

Describe your complaint: Provide details such as names, dates, amounts, type of securities, description of financial harm or abuse, etc.   * This is a required field
Approximate time frame of the activities described above (e.g. from 12/23/2010 to 04/04/2011):
Enter date from:		Enter date 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)? (Check all that apply)
Securities and Exchange Commission
FINRA
Other state regulators
Stock exchanges or NASDAQ
Law enforcement (enter name of agency below):
Others (describe below):
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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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 your complaint.
	Use this button to start over, or if you do not want to submit this complaint.