COMPLAINT FORM

You may use this form to send your complaints to the BVI Financial Services Commission (the “BVIFSC”).
This form can also be printed and submitted by mail or fax if you are concerned about security. However
submission by email is preferred and recommended.

1. Personal Information
* These are all required fields.

* First Name: ‫ﺃﺳﻤﻚ ﺍﻷﻭﻝ‬ Middle Initial:

* Last Name: ‫ﺍﻹﺳﻢ ﺍﻷﺧﻴﺮ‬

Occupation:

Country of Citizenship: ‫ﺍﻟﺠﻨﺴﻴﺔ‬

*Country of Residence: ‫ﺑﻠﺪ ﺍﻹﻗﺎﻣﺔ‬

*Street Address: ‫ﺍﻟﻌﻨﻮﺍﻥ ﻛﻤﺎ ﻓﻲ ﺣﺴﺎﺏ ﺍﻟﺘﺪﺍﻭﻝ‬

‫ﺍﻟﻤﺪﻳﻨﺔ‬
*City: *State/Province: *Zip/Postal Code:

‫ﺍﻟﺒﻠﺪ‬
*Country:

Contact Information:

‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬
Daytime Phone: Alternate Phone:

‫ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
Fax: E-mail:
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2. Tell Us About the Firm or Individual You Have a Complaint Against

*Company or
WORLDWIDE MARKETS LTD.
Individual Name:

Type of Company:

Dealing in Investments, Forex Broker

Occupation/Activity:

Trident Chambers, Number 146, Road

Street Address:

*City: Town Tortola *State/Province: *Zip/Postal Code:

British Virgin Islands

*Country:

E-mail: sales@worldwidemarkets.com

worldwidemarkets.com
Website:

Are you aware of other complainants / persons that have been affected:

Yes No

If yes, can you provide us with contact details (Names, Addresses, Phone, E-mail) and any information those
persons would be willing to share with us:

‫ﺃﻛﺘﺐ ﺃﺳﻤﺎء ﻭﺇﻳﻤﻴﻼﺕ ﻭﺃﺭﻗﺎﻡ ﺍﻷﺷﺨﺎﺹ ﺍﻟﺬﻳﻦ ﻟﺪﻳﻬﻢ ﻧﻔﺲ ﺍﻟﺸﻜﻮﻯ ﻭﻣﺘﻀﺮﺭﻳﻦ ﻣﺜﻠﻚ‬
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3. Tell Us About Your Business Relationship1 / Transaction2 (one-off transaction)

4. Tell Us About Your Complaint

* Please describe your complaint in as much detail as possible.

If your complaint relates to an account or contractual agreement, please include the full name(s) on the account, the exact type of
account, (if you are not the party affected and filing a complaint on behalf of the affected person, please provide the details
of the affected person to avoid delays in the investigation) the date/period of specific transactions or communications and the
names of all persons at the Company you have contacted about this complaint:

1
“Business relationship” means an association between individuals and/or companies entered into for profit making purposes and sometimes
formalized with legal contracts or agreements.
2
“One-off transaction” means any transaction carried out other than in the course of an established business relationship.
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Would you be able to provide us with any or all of the following documents:

Contracts/agreements

Account statements

Canceled Cheques/wire transfers/receipts

Correspondence to and from Company

Advertising or Marketing Material

Any BVI incorporate documents (certificates, resolutions, memorandums)

Other (anything documents you feel will assist us with the investigation)

* Please tick the relevant documents being submitted and be sure to attach as PDF docs.

5. Tell Us About Any Transfer of Funds to the Entity/Individual Who is Subject to the
Complaint

Please state the dates and amounts of all payments made by you to the recipient and, if possible, enclose a
copy of your bank statement with the payments highlighted. If any payments were made in cash, please
state the dates and amounts and provide details of the recipient.

If a bank was used to transfer funds, please provide the following details regarding the receipient’s bank:

‫ﺍﻛﺘﺐ ﺗﻔﺎﺻﻴﻞ ﺍﻟﺒﻨﻚ ﺍﻟﺬﻱ ﻗﻤﺖ ﺑﺘﺤﻮﻳﻞ ﺍﻻﻣﻮﺍﻝ ﻟﻪ ﻋﻠﻰ ﺍﻟﺸﺮﻛﺔ‬

Beneficiary Name:

Beneficiary Address:

Beneficiary Bank:

Bank Address:

Bank sort code (if applicable):

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Beneficiary Account Number(s):

Beneficiary IBAN:

BIC/SWIFT:

6. Tell Us What Actions You Have Taken

Have you filed a complaint(s) with the Company? If yes, please provide copies of the complaint(s)
and any response received from the Company.

Yes No

Have you contacted any other regulator or law enforcement? If yes, please indicate who and the
outcome. (continued on page 7)

Yes No
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Have you initiated legal proceedings, if yes, what type:

Mediation

Arbitration

Court Action

Other

Describe the details of the legal action you have initiated.

Other details if any, pertinent to information provided above that may assist the investigation: