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