Your submission

Action to date

Yes, I have previously lodged or registered this dispute with the Finance & Liquidity Commission No, I have not previously lodged or registered this dispute with the Finance & Liquidity Commission

Applicant details

Dispute details

Please provide a reference number so that your financial services provider can locate the correct information

Please describe the nature of your complaint.

Please include as much information as you can, including the type of product involved, the dates the problem occurred, the name, address and telephone number (if you know these) of all individuals and firms involved and a description of the problem (please attach a separate page if you need more space than provided)

Additional Comments

What do you think is a fair and reasonable resolution to the dispute?

Supporting documents

Please attach copies of all documents you have that relate to your dispute. If your financial services provider has written to you about your dispute, please ensure that you provide a copy of its response.

Please do not submit the following information:

• Personal ID documents: passports, driver’s licenses or other forms of personal identification
• Financial documents: bank statements, debit/credit card details
• Login information: usernames or passwords for trading, banking or other accounts

Please note: Financial Commission representatives will never ask you for your personal or financial details in the process of handing client disputes

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