Complaint form

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Personal data

Last name / Legal entity name

First name

Registration number & LEI

Address (street, number, floor / registered office)

Postcode

City

Country

Phone number

Contact Details

My contact details are the same as above

Last name / Legal entity name

Contact first name

Contact registration number & LEI

Contact address (street, number, floor / registered office)

Postcode

City

Country

Phone number

Personal Data of the Legal Representative

My contact details are the same as above

Last name / Legal entity name

First name

Registration number & LEI

Address (street, number, floor / registered office)

Postcode

City

Country

Phone number

Information About the Complaint

Investment/agreement reference(s) (ID, project name, transaction references)

Subject matter of complaint (free text)

Date(s) of facts/events generating the complaint

Description of damage/loss/detriment (if relevant)

Other comments or relevant info (optional free text)

Submission & Confirmation

Place

Date

Signature

Power of attorney (if representative)

Contractual docs of investment

Other supporting docs

Complaint form

Personal data

Information About the Complaint

Submission & Confirmation

Investing

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