Compliance

Claim Form

COMPLAINT SUBMISSION FORM

To be submitted by the customer to the provider of crypto-asset services

Please upload a copy of your existing contract with us to proceed with the complaint submission*.

Upload Contract:

1.a Complainant’s Information

Entity Name:

Full Name*:

EUID or National ID Number:

Address (Street, House Number)*:

Postal Code*:

City:

Country*:

Phone*:

Email Address*:

1.b Contact Details (if different from 1.a)

Last Name:

First Name:

Address (Street, House Number):

Postal Code:

City:

Country:

Phone:

Email Address:

2.a Information on the Legal Representative (if applicable)

Attach a power of attorney or other official document proving authorization to act as a representative*:

Upload Document:

Entity Name:

Full Name:

Registration Number and LEI (if available):

Address (Street, House Number):

Postal Code:

City:

Country:

Phone:

Email Address:

2.b Contact Details (if different from 2.a)

Last Name/Entity Name:

First Name:

Address (Street, House Number):

Postal Code:

City:

Country:

Phone:

Email Address:

3. Complainant’s Statement

3.a Complete details of the crypto-asset service related to the complaint

Details of the crypto-asset service*:

3.b Description of the Complaint

Description of the Complaint*:

Upload Supporting Documents:

Upload Files:

3.d Description of any damage, loss, or disadvantage suffered (if applicable)

Description of damage, loss, or disadvantage:

3.e Additional comments or relevant information (if applicable)

Additional comments:

I confirm that I have read and agree to the Privacy Policy and consent to the sharing of my submitted data with the responsible third party for the purpose of processing my complaint*.

Need Help?

If you have questions about the complaint process, please contact us.

office@validvent.com Back to Claim Management