ANNEX
Standard format for the submission of complaints
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SUBMISSION OF A COMPLAINT (to be sent by the client to the crowdfunding service provider) |
1.a Personal data of the complainant
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LAST NAME/LEGAL ENTITY NAME |
FIRST NAME |
REGISTRATION NUMBER AND LEI (IF AVAILABLE) |
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ADDRESS: STREET, NUMBER, FLOOR (for firms registered office) |
POSTCODE |
CITY |
COUNTRY |
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TELEPHONE |
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1.b Contact details (if different from 1.a)
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LAST NAME/LEGAL ENTITY NAME |
FIRST NAME |
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ADDRESS: STREET, NUMBER, FLOOR (for firms registered office) |
POSTCODE |
CITY |
COUNTRY |
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TELEPHONE |
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2.a Personal data of the legal representative (if applicable) (a power of attorney or other official document as proof of the appointment of the representative)
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LAST NAME |
FIRST NAME/LEGAL ENTITY NAME |
REGISTRATION NUMBER AND LEI (IF AVAILABLE) |
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ADDRESS: STREET, NUMBER, FLOOR (for firms registered office) |
POSTCODE |
CITY |
COUNTRY |
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TELEPHONE |
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2.b Contact details (if different from 2.a)
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LAST NAME/LEGAL ENTITY NAME |
FIRST NAME |
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ADDRESS: STREET, NUMBER, FLOOR (for firms registered office) |
POSTCODE |
CITY |
COUNTRY |
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TELEPHONE |
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3. Information about the complaint
3.a Full reference of the investment or agreement to which the complaint relates (i.e. investment reference number, name of the project owner/company or crowdfunding project, other references of the relevant transactions…)
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3.b Description of the complaint’s subject-matter (please clearly specify the subject matter of the complaint)
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Please provide documentation supporting the facts mentioned.
3.c Date(s) of the facts that have generated the complaint
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3.d Description of damage, loss or detriment caused (where relevant)
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3.e Other comments or relevant information (where relevant)
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In |
(place) |
on |
(date) |
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SIGNATURE |
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COMPLAINANT/LEGAL REPRESENTATIVE Documentation provided (please check the appropriate box): |
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Power of attorney or other relevant document … |
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Copy of the contractual documents of the investments to which the complaint relates … |
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Other documents supporting the complaint: |
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