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Your details

1. Your name *

2. Your address *

3. Your email *

4. Your daytime telephone number *

5. Your age


Firm details

6. Name of the firm

7. Address of the firm

8. What is the telephone number of the firm that contacted you?

9. What is the website address of the firm that contacted you?

10. How were you initially contacted?

11a. Name(s) of the person(s) who contacted you?

11b. When were you first contacted?


Details of the transaction

12. What was the firm offering to do?

Which company are the shares in?

13. If not shares, which investments did they contact you about?

14a. Were you told that you would need to pay a commission or fee?

14b. What was the fee for? (legal advice, derestriction of shares, etc?)

14c. Do you have your share certificate?

14d. If yes, please provide the following:
Price for share:

Number of shares purchased:

15. Any further comments

Please, send us any documents to [email protected]

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