Form 08-115a - Complaint Form - State Of Alaska Division Of Banking And Securities Page 8
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918. If your complaint involves a broker-dealer, broker-dealer agent, investment adviser or investment
adviser representative, may the Division send a copy of your complaint to the entity or individual that
you have complained against?
Yes
No
(Please note that a "No" response may limit the Division's ability to investigate your complaint.)
I hereby certify that I have read the information contained in and attached to this complaint and that
all information I have given is accurate and complete to the best of my knowledge and belief. I
understand that I can be held responsible if I make a false report. I will cooperate with the Division,
but I understand that the Division's attorneys are not my personal attorneys, and that I am
encouraged to seek private legal counsel in order to protect my interests.
Notice of application of the public records provisions of Alaska law.
Under the public records provisions of Alaska law, AS 09.25.100 – 09-25.220, this complaint may
become subject to public disclosure at some time after the investigation is ended. While it is not
subject to public disclosure, your identity will be made known to the person or company being
complained of unless you indicate a good reason why it should not be released.
Signature: ______________________________________
Date: _________________________________________
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