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Complaint Form

Please refer to the attached Privacy Act Statement that sets forth your rights with regard to submitting data to CFTC.

NOTE: This form is best viewed using IE 7.0 and higher and Firefox 3.0 and higher

Important Instructions: In order for us to best understand your information, we encourage you to answer all the questions that you can. However, only those fields with an asterisk are required. When providing information, please be as specific as you can and provide as much detail as possible. We encourage you to submit any documents relevant to your information by accessing the File Uploads section of this form where you can select, add, or delete your documents.

After 65 minutes of inactivity, your form will timeout and all data will be lost. You will then need to re-access the form and enter your data again.

SECTION 1. DESCRIBE YOUR COMPLAINT

1. Please select the option(s) that best describes your complaint.

If yes, which of the following apply:

SECTION 2. TELL US ABOUT THE INDIVIDUAL AND/OR FIRM YOU ARE COMPLAINING ABOUT

Important Instructions:  Please provide the following information to the extent known for each individual or firm that is a subject of your complaint. To add additional individuals or firms, provide the information below for the first individual or firm, and then select the "Add Individual/Firm" button at the end of Section 2.

Individual/Firm 1

SECTION 3. TELL US ABOUT YOU

Important Instructions: You may provide information for multiple individuals or attorneys by pressing "Add Submitter" or “Add Attorney” after each entry.

Submitter Section 1

Attorney Section 1

SECTION 4. TELL US ABOUT THE INSTRUMENTS INVOLVED IN YOUR COMPLAINT

Important Instructions:  Please provide as much of the following information as possible relevant to your complaint. Select at least one or more of the options below that best describes the type of instrument involved.

Select the type of instrument involved in your complaint: *

FILE UPLOADS

CERTIFICATION