CONSUMER DISPUTE RESOLUTION SCHEME E-FORM
COMPLAINANT CONTACT INFORMATION





POLICY INFORMATION



FIRM INFORMATION (Against whom you are making allegations)



COMPLAINT

Briefly describe the claim, provide background information on the claim, the grounds of why your claim was rejected and the reason you are challenging the final response from the firm.

If there is more than one allegation, number each allegation and use as many pages as necessary.

(a brief summary of the complaint, include all essential information and relevant dates and put down the facts chronologically).


(if received) Attach final response


(insert reasons why you are rejecting/challenging the resolution of your complaint/claim)


• details of the communications you have had with the firm about your complaint including emails, letters, telephone calls



Declaration

I hereby declare that all information provided herein is true to the best of my knowledge and that all documents provided with this report are true and accurate copies of the originals.

I understand that the QFC Regulatory Authority will use the information provided in this report to investigate the matters disclosed in the report in accordance with the applicable rules, policies and procedures.

By pressing the “Submit” button below, I consent to the processing by the QFC Regulatory Authority of my personal data set out in this report.