Read this firstYou can use this form to make a complaint to ASIC...

Read this first
You can use this form to make a complaint to ASIC about a company. If you want to make a
1300 300 630 for information.

Confidentiality

ASIC considers your complaint to have been given to us in confidence and we will not reveal the
contents of your complaint without your consent unless we are required or authorised to do so under
law.
When we receive your complaint, we read the material you have provided to decide whether it is a
matter that ASIC should consider further. There are certain situations where it may be appropriate
for ASIC to either refer your complaint to another organisation or agency, or where we need to make
further inquiries relating to your complaint. To allow us to take action on your complaint as soon as
possible, please answer the following two questions:
Complaint form
Tell us your daytime
telephone number as it is
quicker to ask about your
complaint by phone.
More questions? Call us on 1300 300 630
ASIC complaint form
Page 2
Authority to release information
Q1 If we consider your complaint falls within the jurisdiction of another government organisation
or agency, in Australia or overseas, do you consent to us referring your complaint information,
including your personal information, to that other government organisation or agency?
Yes No (Circle one only)
Q2 If we need to make further inquiries about your complaint, do you consent to us contacting the
subject(s) of your complaint?
Yes No (Circle one only)
What best describes your connection with this complaint?
Anonymous
Accountant
Company officer (current)
Company officer (former)
Competitor
Consumer Advocate or Financial Counsellor
Credit Consumer
Creditor
Customer
Employee
General public
Investor/shareholder
Lawyer
Media
Small Business Owner
Where did the events that led to your complaint occur?
Australian Capital Territory
Northern Territory
New South Wales
Queensland
South Australia
Tasmania
Western Australia
Victoria
More questions? Call us on 1300 300 630
ASIC complaint form
Page 3
Tell us who you want to complain about.
You can complain about a company or a person. Give us as much information as you can. If you
want to tell us about more than two companies or more than two people please include the details
of the other companies or people on a separate page. If your complaint is about a company and a person,
include information about both.
Companies
Company 1
Name of company
Company or Organisation number, if known
Address of the company
Care of
Office, Floor, Building
Street number and street name
Locality State
Postcode Country
Website address
Phone ( )
Fax ( )
Company 2
Name of company
Company or Organisation number, if known
Care of
Office, Floor, Building
Street number and street name
Locality State
Postcode Country
Website address
Phone ( )
Fax ( )
More questions? Call us on 1300 300 630
ASIC complaint form
Page 4
Give us as much information as you can. If you want to tell us about more than two people please
include the details of the other people on a separate page.
People
Person 1
Mr/Ms/Mrs
(given name) (family name)
Address of the person
Care of
Office, Floor, Building
Street number and street name
Locality State
Postcode Country
Email address
Phone ( )
Mobile
Fax ( )
Person 2
Mr/Ms/Mrs
(given name) (family name)
Address of the person
Care of
Office, Floor, Building
Street number and street name
Locality State
Postcode Country
Email address
Phone ( )
Mobile
Fax ( )
More questions? Call us on 1300 300 630
ASIC complaint form
Page 5
Tell us about your complaint
To help us to understand whether we can help you there is some information we would like you to give
us:
How much money or property is involved? AU$
If no money or property is involved or the amount is unknown, write zero.
Have you, or another person that you know of, started legal action over this complaint?
Yes No (please circle)
Please tick any of the following organisations if you have contacted them about your complaint.
Australian Competition and Consumer Commission
Australian Federal Police
Australian Prudential Regulation Authority
Australian Taxation Office
Consumer credit legal centre
Credit/consumer counsellor
Credit Ombudsman Service Limited
Fair Trading or Consumer Affairs
Financial Ombudsman Service Limited
State Police
Superannuation Complaints Tribunal
When did the events that led to your complaint happen?
Enter Month and Year eg 01/2004
Tell us what happened
Describe events in the order they happened. Include dates.
More questions? Call Infoline on 1300 300 630
ASIC complaint form
Page 6
Continue on a separate page if you need more space
More questions? Call us on 1300 300 630
ASIC complaint form
Page 7
Date
What date did you post or fax your complaint?
Documents
If you have relevant documents (for example, statements or invoices) please send us a copy. Do not send us
the original documents now. Keep original documents in a safe place in case they are needed later.
What happens now?
Thank you for telling us about your complaint.
When we receive your complaint we will write to you to confirm receipt. When you receive that letter
you will notice that it also gives you a reference number for further inquiries, and will usually have contact
details for the officer who is dealing with your complaint.
We deal with most complaints within 28 days, however, if we need to make external inquiries this may
take longer. We will inform you of our decision in writing as soon as possible.
Post this form
ASIC Complaints
Australian Securities and Investments Commission
GPO Box 9827
Your Capital City
Fax numbers for ASIC offices are listed on our website at www.asic.gov.au?see Contact us.
Jun10