Complaint Form (Investor)

INSTRUCTIONS FOR COMPLETING THE COMPLAINT FORMThe New Hampshire Bureau of Securities Regulation is responsible for regulating securities activitiesin the State of New Hampshire. We oversee the firms and individuals who offer or sell securities oroffer investment advice to the public.Before filling out the complaint form, please take the time to read these instructions. They will helpyou to understand our functions, and we will be better able to understand and act on your complaint.WHAT WE CAN DO: We investigate complaints against individuals, business corporations, and other entities for possibleviolations of the registration, licensing, or anti-fraud provisions of the Revised Statutes Annotated421-B. We are empowered to bring administrative actions or civil law suits to stop these violations,render sanctions, and, in appropriate cases, to refer matters for criminal prosecution. It is in the publicinterest to report alleged violations of the securities laws, and we encourage you to do so.WHAT WE CANNOT DO:We cannot act as a court of law. We cannot order that monies be refunded or that damages be paid. Insome instances restitution or rescission is made to investors as a result of this agencys action, but thoseinstances are not the norm. You should not rely on us to get your money back for you. We cannotenforce the Business Corporation Laws, partnership laws, contract laws, or regulate the offerand sale of annuities. We cannot give legal or financial advice or act as your attorney.HOW YOU CAN HELP US:Organize your complaint using these guidelines:1. First, make a separate list of the things you want to say. Separate your feelings from the facts.2. Type or print clearly in ink. Fill out each section to the best of your ability. In this form, specifically question 14, present the events in the order in which they happened, using dates whenever possible. a) Tell us WHAT happened. Start from the beginning. Be specific as to what was said and who said it. b) Tell us HOW you first learned of the investment opportunity or investment service. c) Tell us WHO was present during these conversations or acts. d) Tell us WHEN and WHERE these conversations/acts took place. e) Tell us WHY you decided to take advantage of the investment or investment service. f) List the names, addresses, and telephone numbers of any others who you believe may have similar complaints. g) Tell us WHEN and WHERE the money and agreements changed hands.3. Enclose copies of documents such as stock certificates, bonds, limited partnership agreements, prospectuses, confirmations, letters, canceled checks (front and back), advertisements, papers, notes, or other documents that may explain your complaint. Do not send originals; we cannot be responsible for their safekeeping.4. Remember that your complaint should describe the event or practice which you believe was unfair. If possible, you should state why the event or practice was improper.<<<<<<<<<********>>>>>>>>>>>>> 2STEPS YOU CAN TAKE IF YOUR COMPLAINT INVOLVES A BROKER-DEALER: Many disputes with brokerage firms can be directly resolved by your doing the following:NOTIFY YOUR BROKER AND YOUR BROKERS MANAGER 1 . Talk to your salesperson about the problem. 2. Negotiate directly with your salesperson to resolve the matter. Frequently, minor issues can be settled informally at this point. 3. If you feel the salesperson has answered your questions unsatisfactorily or is unwilling to review your complaint, contact the salespersons supervisor, as well as the office manager.4. Write to the firms chief compliance officer. This individual is located at the firms home office address. response in writing from the compliance officer. (You can get the name Request a of the compliance officer and the firms home address from the brokers office.)ARBITRATION PROCEDURES The United States Securities and Exchange Commission has approved certain arbitration proceduresfor resolution of disputes between investors and broker-dealers. Arbitration is a method of having adispute between two or more parties resolved by an impartial person who is knowledgeable in the areasof controversy. Arbitration generally is quicker and less expensive than using the courts to resolve acomplaint. Because of this, arbitration has long been used as an alternative to the courts. Once thearbitrator has made a decision, the decision is final and is subject to review by a court only on a verylimited basis. Also, if arbitration is chosen as a means of resolving a dispute, the complaining partygives up the right to pursue the matter through the courts. Further, based upon the contract entered into between you and your broker, you may be obligated tosubmit the dispute to arbitration in lieu of litigation through the courts.If you are interested in learning more about the arbitration process, you can contact the NationalAssociation of Securities Dealers (NASD) or the New York Stock Exchange (NYSE) with which yourbroker-dealer is a member. The address for the NYSE and the NASD are: New York Stock Exchange National Association of Securities Dealers, Inc. 11 Wall Street 33 Whitehall Street New York, NY 10005 New York, NY 10004 Telephone: (212) 656-3000 Telephone: (212) 480-4881If you have any questions concerning this form, you may call the New Hampshire Bureau of SecuritiesRegulation at (603)271-1463, between 8:00 a.m. and 4:30 p.m. Upon completion of all sections, please mail the complaint form along with copies of any supportingdocuments to: New Hampshire Bureau of Securities Regulation State House Room 204 Concord NH 03301-4989 (603) 271-1463 PLEASE NOTE: As part of the complaint handling process, the Bureau may send a copy of thisform to the broker-dealer firm against whom your complaint is filed.<<<<<<<<<********>>>>>>>>>>>>> 3 State of New Hampshire Department of State Bureau of Securities Regulation Mailing Address Location State House, Room 204 State House Annex Concord New Hampshire 03301-4989 25 Capitol St. Concord, New Hampshire 03301 TTY/TDD Relay (603) 225-4033 COMPLAINT FORM We appreciate your interest and will proceed with a preliminary investigation as soon as this form is returned, along with any documentary evidence that you may have. Please remember to attach a copy of any written materials (i.e. checks, contracts, advertisements, letters, etc.) that may relate to your complaint I. Personal Information LAST NAME FIRST MIDDLE CURRENT DATE HOME ADDRESS CITY STATE ZIP PHONE NO. BUSINESS ADDRESS CITY STATE