Form 08-115a - Investment Complaint Form printable pdf download

Form 08-115a - Investment Complaint Form

INVESTMENT COMPLAINT FORM

This form can be completed on line, downloaded, signed, and submitted to the division by fax, or you

can complete it and mail it in to the division if a lot of other materials must be sent with it.

The jurisdiction of securities officials extends only to those matters that are defined as securities

under the Alaska Securities Act. Generally, these are investments. We do not have jurisdiction over

matters that have to do with the functioning of corporations and other business entities involving

failures or acts of management with which you disagree. You may have civil remedies, but the

division lacks the ability to become involved. An exception to this is the requirement that certain

ANCSA corporations and their members are required to file proxy solicitations and certain other

materials with the division. You may call the division to inquire about these matters if you have

questions. THIS FORM SHOULD NOT BE USED FOR COMPLAINTS ABOUT ANCSA

CORPORATIONS. USE FORM 08-115B POSTED ON THE DIVISION WEB SITE FOR THOSE

COMPLAINTS.

Name, address, and telephone number of person filing this complaint:

Full name

Address

Work phone and best time to call:

Home phone and best time to call:

Fax

Please give your E-mail address if you have one:

This complaint is about q q an individual q q a company. The name, address, and phone number are: (If

more than one individual, please give the other names, addresses, and phone numbers that you have)

Name of company and/or individuals

Address

Phone

This complaint is about q q a corporation, q q a partnership, q q a limited partnership, q q a limited

liability company, or q q a limited liability partnership formed under the laws of the state of

q q I don’t know what form or state is involved.

__________________________ .

Please provide a brief description of your complaint below. (How much money is involved? What

form of exchange did you use (cash, check, etc.)? What kind of investments did you buy? When did

you make the investment? How were you approached to make the investment? Please give all

names of persons connected with the investments and how they were involved.)

08-115A (08/01)

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Form 08-115a - Investment Complaint Form