Form IPB001 "Investor Protection Bureau Complaint Form" - New York

What Is Form IPB001?

This is a legal form that was released by the New York State Attorney General - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the New York State Attorney General;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form IPB001 by clicking the link below or browse more documents and templates provided by the New York State Attorney General.

ADVERTISEMENT
ADVERTISEMENT

Download Form IPB001 "Investor Protection Bureau Complaint Form" - New York

Download PDF

Fill PDF online

Rate (4.8 / 5) 81 votes
Page background image
COMPLAINT FORM 
Investor Protection Bureau
Consumer Hotline For Hearing Impaired 
New York State Office of the Attorney General
28 Liberty Street
1 (800) 771­7755  
TDD (800) 788­9898 
New York, New York 10005
ag.ny.gov 
(212) 416-8222 (phone)
(212) 416-8816 (fax)
Instructions for filing a complaint:
Return To: 
Investor Protection Bureau 
1. Please type or print clearly
New York State Office of the Attorney General 
2. Please complete the entire form
28 Liberty Street
3. Please enclose copies of any documents relating to this complaint
New York, New York 10005 
Your Contact Details
First Name
Last Name
Street Address
City/Town
State
Zip
(ex:12345 or 12345­1234)
County
Home Phone
Business Phone
(ex:999­999­9999 or 999­999­9999 x9999)
(ex:999­999­9999 or 999­999­9999 x9999)
Mobile Phone
Email Address
(ex:999­999­9999 )
COMPLAINT FORM 
Investor Protection Bureau
Consumer Hotline For Hearing Impaired 
New York State Office of the Attorney General
28 Liberty Street
1 (800) 771­7755  
TDD (800) 788­9898 
New York, New York 10005
ag.ny.gov 
(212) 416-8222 (phone)
(212) 416-8816 (fax)
Instructions for filing a complaint:
Return To: 
Investor Protection Bureau 
1. Please type or print clearly
New York State Office of the Attorney General 
2. Please complete the entire form
28 Liberty Street
3. Please enclose copies of any documents relating to this complaint
New York, New York 10005 
Your Contact Details
First Name
Last Name
Street Address
City/Town
State
Zip
(ex:12345 or 12345­1234)
County
Home Phone
Business Phone
(ex:999­999­9999 or 999­999­9999 x9999)
(ex:999­999­9999 or 999­999­9999 x9999)
Mobile Phone
Email Address
(ex:999­999­9999 )
Details Regarding the Company And/Or Individual You Are Complaining About
Company Name *
Street Address
Street Address2
City/Town
State
Zip
(ex:12345 or 12345­1234)
County
Phone
Salesperson's Name
(ex:999­999­9999 or 999­999­9999 x9999)
Specifics Regarding Your Complaint
Date of Transaction
Nature of Investment
Total Amount of Investment
Did You Receive the Security You
No
Yes
Purchased?
Fully Explain the Nature of Your Complaint in the Box Below.
Alternatively, You May Upload a Written Description of Your
Complaint as an Attachment to this Form.
What Relief Are You Seeking?
Actions Taken To Date
Have You Complained to the Company?
No
Yes
*
If Yes, provide the following details:
Date of Complaint
What was the company’s response, if any?
Name and Title(s) of Individual(s) to whom you complained
Have You Complained to the Individual? *
Yes
No
If Yes, provide the following details:
Date of Complaint
What was the individual’s response, if any?
Name and Title(s) of Individual(s) to whom you complained
Do you have an attorney?
Yes
No
Is There Any Court Action Pending?
Yes
No
In submitting this form, complainant understands that (please check each box below):
The Attorney General is not my private attorney, but represents the public in enforcing laws designed to protect the public from
misleading or unlawful business practices. My filing this complaint does not mean that the Attorney General has initiated (or
will initiate) a lawsuit or proceeding on my behalf.
The Attorney General cannot give me legal advice or represent me in court. If I have any questions concerning my legal rights
or responsibilities, I should contact a private attorney.
The Attorney General may send a copy of my complaint and any documents I provide to the person or business about whom I
am complaining and I authorize that person or business to release information concerning my complaint to the Attorney
General.
The Attorney General works with other state, local and federal government agencies to investigate complaints and coordinate
law enforcement and may also share my complaint with them. In addition, the Attorney General may use information from my
complaint in legal proceedings to establish violations of law.
Any false statements made in this complaint are punishable as a Class A Misdemeanor under Section 175.30 and/or Section
210.45 of the Penal Law.
By signing or typing my full name below, I certify that the above complaint is true and accurate to the best of my knowledge
and that any documents attached are true and accurate copies of the originals.
Signature
Date
IPB001 - (rev. 4/18)
Page of 4