If you would like to fill out a PDF Version of the Complaint Form and mail it to us, please click the link below.

Complaint Form-PDF Version

Submit the form below if you believe you have been the victim of securities fraud or would like the Securities Division of the Nevada Secretary of State to investigate a potential violation of NRS 90 or 91.  This online complaint form will be utilized for investigatory purposes so it is important to fill out each field and provide as much information as possible. 

 

The Securities Division CAN:

• Investigate complaints against individuals, corporations, and other business entities for violations of registration, licensing, or anti-fraud provisions of Nevada securities and/or commodities law. 

• Initiate administrative and/or civil actions to stop these violations and/or to impose civil penalties. 

• Investigate complaints of criminal violations of Nevada securities and/or commodities law and refer cases for criminal prosecution to the Nevada Attorney General.

The Securities Division CANNOT:

• Guarantee that your investment money will be repaid to you.

• Give legal or investment advice.

Please note that the Division is not a consumer advocacy organization, as our primary function is the administration of the Nevada Uniform Securities Act.  While we continue to review the facts and circumstances surrounding your complaint, please be aware that the filing of a complaint with the Division should not be viewed as a substitute for filing a civil action.  If you believe you are entitled to recover money in this matter, you should consult with an attorney regarding your rights. A separate civil action will not interfere with any actions taken by the Division.

 

Pursuant to NRS 90.730, information or records obtained by the Division in connection with an investigation concerning possible violations of the Nevada Uniform Securities Act including complaints received by the Division is considered confidential and non-public information.  As a matter of practice, we neither confirm nor deny the existence of or status of any investigations undertaken by the Division.

 

 

* You must complete this information.

Tell Us About Yourself

1

Personal Information 

 *

Personal Information

Title	First Name*
Middle Initial	Last Name*
Street Address*	City*
State/Province*	Zip/Postal Code*
Country*	Daytime Phoneext.
Alternate Phone ext.	E-mail*
Age

2

Are you a:

Are you a:(Select an Answer) Individual Investor Registered Representitive Accountant Other Financial Professional Issuer/Attorney for an Issuer Brokerage Firm Compliance Officer Academic/Researcher/Student Member of the Press

3

Level of Education Completed: 

Level of Education Completed: (Select an Answer) High School Bachelor of Science/Arts Masters/MBA Doctorate PhD Other

Tell Us About the Firm or Individual You Have a Complaint Against

4

Firm or Individual Information

Firm or Individual Information

Firm Name	Broker, Advisor, Salesperson, or Individual name
Street Address	City
State/Province	Zip/Postal Code
Country

5

If a complaint against a firm, type of firm:

If a complaint against a firm, type of firm:(Select an Answer) Bank Broker - Dealer Day Trading Firm Insurance Company Investment Advisor/Financial Planner Marker Maker Mutual Fund Newsletter Company/Investment Publication Company On-line Trading Firm Private/Closely Held Company Public Company Transfer Agent Other

6

Manner of offering

Manner of offering

Telephone Solicitation	Personal Visit
Newspaper	Television
Internet	Radio
Letter/Mail	Advertising Pamphlet
Group Sales Presentation	Other If other, type text here.

7

Where was the salesperson physically located at the time of the sale? 

Where was the salesperson physically located at the time of the sale?

8

If the sale was made by telephone, from what location was the salesperson calling you? (Address, City, State)

If the sale was made by telephone, from what location was the salesperson calling you? (Address, City, State)

Tell Us About Your Investment

9

Type of security:

Type of security:(Select an Answer) "Prime Bank" securities ADRs Bank issues (general) Blank Check offerings Blind pool offerings Certificates for deposit Closed-end Funds Coins and precious metals (gold, silver, etc.) Collateralized mortgage obligations (CMOs) Commodities futures (except stock index) Commodity Stock Index Options Convertible securities Currency transactions Debt securities (general) Derivatives (general) Diamonds and other precious stones Equity security (general) Foreign Securities (not ADRs) Cryptocurrencies Promissory notes Franchises and other business ventures

10

Name of Issuer or Security

Name of Issuer or Security

Tell Us About Your Complaint

11

* Please describe your complaint in as much detail as possible, including the full name(s) on the account, the exact type of account, the dates of specific transactions or conversations, the name or ticker symbol of the security(ies) involved, and the names of all the people at the firm you have contacted about this complaint.

Please refrain from providing sensitive or confidential information in this form.  Further details can be provided separately if necessary.

* Please describe your complaint in as much detail as possible, including the full name(s) on the account, the exact type of account, the dates of specific transactions or conversations, the name or ticker symbol of the security(ies) involved, and the names of all the people at the firm you have contacted about this complaint. Please refrain from providing sensitive or confidential information in this form. Further details can be provided separately if necessary.

12

Primary Violation:

Primary Violation:

Excessive Trading	Errors in processing orders
Excessive Fees	Fail to execute
Forgery	Identity theft
Fraud	Other If other, type text here.

13

Do you know the name of the bank or account in which your money was deposited? If so, please provide details.

Do you know the name of the bank or account in which your money was deposited? If so, please provide details.

14

Amount in Dispute:

Amount in Dispute:

15

If the investment was cash, did you receive a receipt or have other documentation?

If the investment was cash, did you receive a receipt or have other documentation?

Yes

No

16

What types of documents would you be able to provide us if requested?

What types of documents would you be able to provide us if requested?

Canceled Checks

Correspondence to and from Firm

Advertising or Marketing Materials

Notes of conversation with Firm

Other If other, type text here.

Tell Us What Action You Have Taken

17

Have you complained to the firm/individual?

Have you complained to the firm/individual?

Yes

No

18

Have you contacted any other regulators?

Have you contacted any other regulators?

Yes

No

19

If yes, whom?

If yes, whom?

FINRA (Financial Industry Regulatory Authority)	State Regulators
Other Federal Regulators	Foreign Regulators
Stock Exchange - NYSE	Stock Exchange - AMEX
Stock Exchange - NASDAQ	Other If other, type text here.

20

Have you taken legal action?   If so, what type:

Have you taken legal action? If so, what type:

Mediation

Arbitration

Civil Action

21

Describe the details of the legal action you have taken.

Please refrain from providing sensitive or confidential information in this form.  Further details can be provided separately if necessary

Describe the details of the legal action you have taken. Please refrain from providing sensitive or confidential information in this form. Further details can be provided separately if necessary

22

Are you willing to testify in a court of Law regarding this case?

Are you willing to testify in a court of Law regarding this case?

Yes

No

Notice:

It is a violation of Nevada law to willfully make a materially false, fictitious or fraudulent statement or representation in an investigation. Violations may subject a person to civil or criminal penalties.

 

In filing this complaint, you are stating the information you are providing us true and correct to the best of your knowledge and that the information may be used by the Division to further investigate your complaint. 

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