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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
Email
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
Email
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
Email
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
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