CBOE Investor Complaint Form

Please complete the complaint form with as much information as possible. This will help lessen the need to contact you further and will allow for the most prompt and thorough investigation of your complaint. All information will be treated in confidence to the fullest extent possible and CBOE Rules enable CBOE to protect the identity of a complainant. However, CBOE cannot guarantee that during the course of completing its investigation or possible prosecution of the matter that the source of the complaint will not become known. Please do not send duplicate copies of your complaint by mail if you are submitting your complaint online.

SUPPORTING DOCUMENTATION

Indicate the type of documentation you are willing to provide to CBOE regarding your complaint should CBOE determine the need to request such documentation from you. Choose all that apply.

None

Trade Confirmation

Monthly Account Statement

Correspondence To and/or From Firm

Notes of Conversations with Firm

Advertising Material

Other

HAVE YOU CONTACTED THE BROKERAGE FIRM?	YES                NO
If yes, please provide the date of contact, name of contact and status/resolution:
HAVE YOU CONTACTED ANY OTHER REGULATORS?	YES                NO
If yes, please indicate all relevant regulators:
HAVE YOU FILED AN ARBITRATION CLAIM?	YES                NO
If yes, please identify the organization(s) with which you filed your claim:

COMPLAINANT INFORMATION
(If you have chosen to remain anonymous, please skip this section and proceed to "Submit Form" below. Fields denoted with "*" are required fields for investors who are providing their identity/contact information).
*Name of Complainant:
*Mailing Address:
*City:		*State:
*Zip/Mail Code:		*Country:
*Day Time Phone:		*E-mail Address:
Please check here if you are acting as an Agent for the complainant and include the following information:
Name of Agent:		Relationship to Complainant: