Complaint Form - Arizona Corporation Commission printable pdf download

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 state 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 PREPARING 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 Division's 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

REV. 1/13/04

Complaint Form - Arizona Corporation Commission