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Complaint Form - Arizona
| Complaint Form Form. This is a Arizona form and can be used in Securities Blue Sky Secretary Of State . |
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Please Read and Detach Prior to Mailing PROCEDURE FOR FILING A COMPLAINT WITH THE SECURITIES DIVISION OF THE ARIZONA CORPORATION COMMISSION The Securities Division of the Arizona Corporation Commission is responsible for regulating the securities industry in the s tate of Arizona. One of our main functions is to oversee the firms and individuals that engage in the offer and sale of securities to the public. We also oversee the individuals and entities that provide investment advice for compensation as defined within the Arizona Investment Management Act. Please complete the attached form if you have information or complaints concerning possible violations of the Securities Act of Arizona or of the Arizona Investment Management Act. SOME TIPS ON PREP ARING A WRITTEN COMPLAINT 1. First, make a separate list of the things you want to say. Try to separate your feelings from the facts. 2. Present the events in the order in which they happened, using dates whenever possible. 3. Type or print in black ink. 4. Enclose copies of documents such as written offering memoranda or other materials, cancelled checks (front and back), purchase agreements, stock certificates, confirmations, letters, advertisements, papers, notes or other documents that may support your complaint. Keep originals for your files. 5. Remember that your complaint should describe the event or practice that you believe was a possible violation. 6. Please COMPLETE the complaint form, DETACH and return it to our office. Our ability to assist you will depend upon your giving us a complete and detailed statement including any misrepresentations made to you. MAIL OR DELIVER YOUR COMPLAINT TO THE PHOENIX OFFICE: Securities Division Arizona Corporation Commission 1300 West Washington, 3rd Floor Phoenix Arizona 85007 FAX: (602) 594-7470 E-MAIL: accsec@ccsd.cc.state.az.us PHONE: (602) 542-4242 Upon receipt of your complaint we will file the complaint in the records of the Arizona Corporation Commission and will consider making an inquiry into the matter. You should be aware that evaluation of your complaint might take several weeks. It is the Divisions policy to conduct inquiries on a confidential basis. This is done to protect the integrity of the investigation and to protect the personal privacy of persons with respect to whom unfounded charges may be made. This Division does not have authority to provide legal or financial advice to investors, or to represent them in connection with their personal rights. Any actions instituted by the Division with respect to alleged or purported violations are limited to remedial and enforcement actions seeking to prevent further violations. Thus, any action by the Division would not necessarily result in any monetary benefit to you. If you have 1 REV. 1/13/04 <<<<<<<<<********>>>>>>>>>>>>> 2suffered monetary loss, you should consider contacting a private attorney to discuss your legal rights and remedies under the Arizona Securities Act or other statutes. If you do not have a private attorney, the County Bar Associations Lawyer Referral Service may be consulted or the local Legal Aid Society may be able to assist you. The United States Securities and Exchange Commission (SEC) has approved certain arbitration procedures for resolution of disputes between investors and broker/dealers. Arbitration is a method of having a dispute between two or more parties resolved by an impartial person who is knowledgeable in the areas of controversy. That person is known as an arbitrator. Disputes between an investor and a broker/dealer often involve complicated issues that, in the interest of fairness, require a prompt and inexpensive means of resolution. Because of this, arbitration has long been used as an alternative to the courts. Once the arbitrator has made a decision, the decision is final and is subject to review by a court only on a very limited basis. Also, if arbitration is chosen as a means of resolving a dispute, the complaining party gives up the right to pursue the matter through the courts. If you are interested in l earning more about the arbitration process, you can contact the National Association of Securities Dealers (NASD) or the Exchange which your broker/dealer is a member. The addresses for the New York Stock Exchange and the NASD are: New York Stock Exchange 11 Wall Street New York, New York 10005 Telephone: (212) 656-2096 Director of Arbitration National Association of Securities Dealers, Inc. 10 South LaSalle Street, 20th Floor Chicago, IL 60603-1002 Telephone: (312) 899-4440 This document and the complaint form are available in alternative formats by contacting Yvonne L. McFarlin, Executive Assistant to the Executive Secretary, voice phone number 602-542-3931, E-mail ymcfarlin@cc.state.az.us 2 REV. 1/13/04 <<<<<<<<<********>>>>>>>>>>>>> 3 THIS DOCUMENT IS AVAILABLE IN ALTERNATIVE FOR MATS BY CONTACTING YVONNE L. McFARLIN, EXECUTIVE ASSISTANT TO THE EXECUTIVE SECRETARY, VOICE PHONE NUMBER 602-542 -3931, E-MAIL YMCFARLIN@CC.STATE.AZ.US COMPLAINT FORM (PLEASE TYPE OR PRINT IN BLACK INK ONLY) State Name and Address of FIRM or PERSON State YOUR Name and Address: Complained Against: ZIP: ZIP: Phone: Home Phone: Name of Stockbroker or Salesperson: Business Phone: Type of complaint: Complaint against a Company or Firm Complaint against an individual Other, Please specify: Date of transaction: Place of Transaction; specify the states in which you and the salesperson were located: Witnesses to the transaction: State the type of investment involved (e.g., stock, note, limited partnership, etc. If you are not certain, describe on last page): -If you invested in stock or bonds, what was the name of the issuing corporation? -If you invested in a note, who was the maker (company or individual) responsible for paying it? -If you invested in a partnership, what was the name of that partnership? Amount involved in transaction: Did you sign any papers or documents? Yes No (If Yes, please attach copies of them.) How did you first learn about this investment? Have you complained to the Company or Firm? Yes No If yes, to whom? When? What was the response? May we send a copy of your complaint to the firm or individual complained against? Yes No Does an attorney represent you in this matter? Yes No If yes, give attorneys name and address: 3 REV. 1/13/04 <<<<<<<<<********>>>>>>>>>>>>> 4 Did you begin any legal action against this company? Yes No Explain: Are you willing to sign an affidavit or t
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