Font Size: AAA // Print // Bookmark

Whistleblower Tips and Complaints

Please refer to the attached Privacy Act Statement, Submission Procedures and Completion Instructions as needed to help you complete this form. Or, to submit the form by mail or facsimile, print out the and mail or fax the completed form to: CFTC, Whistleblower Office, 1155 21st Street, NW, Washington, DC 20581. Fax Number (202) 418-5975.

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

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 A. Tell us about yourself

Complainant

SECTION B. YOUR ATTORNEY'S INFORMATION (If Applicable – See Instructions)

If you are represented by an attorney, or if you are an attorney filing on behalf of your client.

SECTION C. Tell us who you are complaining about

Individual/Entity

SECTION D. Tell us about your complaint

RadDatePicker
Open the calendar popup.
RadDatePicker
Open the calendar popup.

SECTION E. Whistleblower eligibility requirements and other information

FILE UPLOADS

SECTION F. Whistleblower's declaration

I declare under penalty of perjury under the laws of the United States that the information contained herein is true, correct and complete to the best of my knowledge, information and belief. I fully understand that I may be subject to prosecution and ineligible for a whistleblower award if, in my submission of information, my other dealings with the Commodity Futures Trading Commission, or my dealings with another authority in connection with a related action, I knowingly and willfully make any false, fictitious, or fraudulent statements or representations, or use any false writing or document knowing that the writing or document contains any false, fictitious, or fraudulent statement or entry.

SECTION G. Counsel certification

I certify that I have reviewed this form for completeness and accuracy and that the information contained herein is true, correct and complete to the best of my knowledge, information and belief. I further certify that I have verified the identity of the whistleblower on whose behalf this form is being submitted by viewing the whistleblower's valid, unexpired government issued identification (e.g., driver's license, passport) and will retain an original, signed copy of this form, with Section F signed by the whistleblower, in my records. I further certify that I have obtained the whistleblower's non-waiveable consent to provide the Commodity Futures Trading Commission with his or her original signed Form TCR upon request in the event that the Commodity Futures Trading Commission requests it due to concerns that the whistleblower may have knowingly and willfully made false, fictitious, or fraudulent statements or representations, or used any false writing or document knowing that the writing or document contains any false fictitious or fraudulent statement or entry, and that I consent to be legally obligated to do so within seven (7) calendar days of receiving such a request from the Commodity Futures Trading Commission.