Complaint Online

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A. Complainant’s Particulars
Name (for individual, name as stated in MyKad or passport)*
MyKad / Passport / Company or Business Registration No.*
Correspondence Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Telephone No.*
Fax No.
E-mail*

C. Particulars of Complaint
(i) Name of distributor*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Telephone No.*
Fax No.
E-mail*
(ii) Name of *consultant*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Telephone No.*
Fax No.
E-mail*
(iii) Have you lodged a report/complaint with the police, other government agency or statutory / regulatory authority?
- Yes.
- No.
I have lodged a report / complaint with:-*
- Police
- Securities Comission
- Others
Date of Police Report*
Report Ref. No.:*
Date of Securities Commission Complaint Filed*
Report Ref. No.:*
Name of organisation*
Date of Report*
Report Ref. No.:*
(iv) State your complaint here in as much detail as possible. Describe the events that happened and the dates on which they occurred:-
(v) Do you have any documents/letters in support of your complaint?
- Yes, I will forward them to the FIMM in due course.
- No.
Disclaimer*
- I confirm that all information and documents provided to FIMM herein are true and accurate. I understand and agree that all information including my personal data which could include sensitive information and documents provided to FIMM or to be given at a later date concerning my complaint may be shared with relevant distributors and consultants registered with FIMM, and/or other third parties as may be necessary as part of FIMM's investigation of my complaint.
Name
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