Instructions
Thank you for providing us with information about a possible violation of the federal securities laws. In the form below, we will ask you about the nature of your tip, complaint, or referral, the persons or entities involved, the investment products involved, and your contact information.
About the SEC’s Whistleblower Program
The Dodd-Frank Wall Street Reform and Consumer Protection Act authorizes the SEC to pay awards, subject to certain limitations and conditions, to individuals who provide us with original information about violations of the federal securities laws. The program also provides anti-retaliation protections for whistleblowers, and enhanced confidentiality protections for information that could reasonably identify a person as a whistleblower. Becoming a whistleblower creates legal protections for you, but it also imposes certain procedural obligations on you. For more information about your rights and obligations as a whistleblower, please visit www.sec.gov/whistleblower.
You are encouraged to submit your information online by filling out the online complaint form. If you would like to be considered for a whistleblower award, you will be required to make a declaration. If you would like to file anonymously as a whistleblower, an attorney must complete this form on your behalf.
If you prefer to submit your information in hard copy, you may print out Form-TCR and submit it:
• By mail: to the Office of the Whistleblower, SEC, 100 F Street, NE, Mail Stop 5971, Washington, DC 20549; or
• By fax: to the Office of the Whistleblower (703) 813-9322.
What is your complaint about?
Please select the option that best describes your complaint. [31]
Fraudulent investment scheme, such as a Ponzi scheme or the promise of high-yield returns
Please select the specific category that best describes your complaint. [32]
Affinity fraud
High-yield investment
Ponzi / pyramid scheme
Other *
Please provide more information. [161]
|
If a return on investment of any amount was guaranteed, what percentage was guaranteed? [33]
[ % ] Enter Percentage Unknown
Enter Percentage % (Enter whole numbers) [173]
|
If you are alleging offering fraud, how was the offer made? [34]
Non-personal message (radio, television, periodical, tout sheet, website)
Personal message (email, voicemail, phone call)
Private placement documents
Public filing made with other agency
Public filing with the SEC
Unknown
Other
For Other, please specify [156]
|
Unregistered securities offering
General trading practices or pricing issues
Please select the specific category that best describes your complaint. [32]
After hours trading
Algorithmic trading/high frequency trading
Bankrupt companies, trading in
Front running
Market Maker activities
Pricing information: inaccurate quotes/pricing information
Trade execution
Other
Please provide more information. [179]
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Manipulation of a security
Please select the specific category that best describes your complaint. [32]
Abusive naked short selling
Orchestrating trading by multiple parties
Pump and dump scheme
Suspicious end of day trading
Wash sales
Other
Please provide more information. [178]
|
Insider trading
Please select the specific category that best describes your complaint. [32]
Close relationship to company
Corporate insider
Outsider who received information improperly
Material misstatement or omission in a company's public filings or financial statements, or a failure to file
Please select the specific category that best describes your complaint. [32]
Audit
Conflicts of interest by management
Corporate governance
Executive compensation
Failure to file reports
Failure to notify shareholders of corporate events
False/misleading financial statements
False/misleading offering documents
False/misleading press release
False/misleading proxy materials
Going private transactions
Internal Controls/Books and Records
Mergers and acquisitions
Proxy materials/prospectus
Reverse stock splits
Selective disclosure - Regulation FD
Shareholder proposals
Tender offers
Municipal securities transactions or public pension plans
Please select the specific category that best describes your complaint. [32]
Failure to file required documents
False/misleading information in official statement documents
Kickbacks or improper payments to municipal issuers
Kickbacks or improper payments to pension associates
Other
Please provide more information. [195]
|
Specific market event or condition
Bribery of, or improper payments to, foreign officials (Foreign Corrupt Practices Act Violations)
Please select the specific category that best describes your complaint. [32]
Bribery of foreign officials
Bribery of foreign officials and Internal Controls/Books and Records Deficiencies
Conduct in sanctioned countries
Disclosure violations arising from bribery of foreign officials
Disclosure violations arising from prohibited conduct in sanctioned countries
Internal Controls/Books and Records Deficiencies
Other
* In your own words, describe the conduct or situation you are complaining about. [172]
|
Are you having or have you had difficulty getting access to your funds or securities? [35]
Yes No Unknown
Did you suffer a loss? [196]
Yes No
Enter amount of loss to nearest dollar without characters (e.g., 15000, not $15,000.00). [174]
|
When did you become aware of the conduct? (mm/dd/yyyy) [38]
|
When did the conduct begin? (mm/dd/yyyy) [39]
|
Is the conduct ongoing? [40]
Yes No Unknown
When did the conduct stop? (mm/dd/yyyy) [41]
|
Has the individual or firm acknowledged the conduct? [42]
Yes No Unknown
How did you learn about the conduct? You may select more than one answer.[43]
Account statements
Broker-dealer records
Conversations
Internal business documents
Publicly available information
SEC filings
Social media (e.g., Facebook, Twitter, blogs, chat rooms, and electronic communities of interest)
Stock tip sheet or newsletter
Have you taken any action regarding your complaint? You may select more than one answer.[44]
Complained to firm
Complained to other regulator
Complained to SEC
Complained to law enforcement
Complained to other
Legal action
Mediation
Arbitration
Other
None
Provide details. [198]
|
Who are you complaining about?
Instructions
Please provide information about each person or firm you are complaining about.
Are you complaining about a person or a firm? [4]
Person Firm
If Person selected:
Select the title that best describes the person or firm that you are complaining about. [5]
Accountant
Analyst Research
Attorney
Auditor
Broker
Compliance officer
Employee
Executive officer or director
Financial planner
Fund manager
Investment adviser representative
Receiver
Stock promoter
Trustee
Unknown
Other
For Other Person, please specify. [176]
|
Where is the person that you are complaining about employed? [25]
|
Are you or were you associated with the person or firm when the alleged conduct occurred? [29]
Yes No Unknown
How are you or were you associated with the person or firm you are complaining about? [30]
|
Person's Title [163]
Mr Mrs Ms
First Name [8]
|
Middle Name [9]
|
Last Name [10]
|
Street Address [11]
|
Address (Continued) [12]
|
Zip / Postal Code [15]
|
City [13]
|
State / Province [14]
|
Country [16]
|
Home Phone [19]
|
Work Phone [20]
|
Mobile Phone [21]
|
Other Phone [22]
|
Email Address [23]
|
Website [24]
|
If Firm selected:
Select the title that best describes the person or firm that you are complaining about. [5]
Accounting Firm
Bank
Brokerage Firm/Broker-Dealer
Clearing Agency
Exchange
Financial Planner
Insurance Company
Investment Adviser
Investment Company
IRA or 401(k) custodian/administrator
Municipal Advisor
Municipal Securities Dealer
Mutual fund
Newsletter company/investment publication companies
Other Regulatory and Self Regulatory Organizations
Private fund company (including hedge fund, private equity fund, venture capital fund or real estate fund)
Private/Closely Held Company
Publicly held company
Transfer agent/paying agent/registrar
Underwriter
Unknown
Other
For Other Firm, please specify.[177]
|
Are you or were you associated with the person or firm when the alleged conduct occurred? [29]
Yes No Unknown
How are you or were you associated with the person or firm you are complaining about? [30]
|
Identifier Type [26]
Ticker Symbol CIK CRD Unknown
Ticker Symbol [27]
|
CIK [28]
|
Enter CRD Number [539]
|
Are you a current or former Employee, Officer, Partner, or Employee Director of any entity you are complaining about? [300]
Yes No
If Yes, Check all that apply. [301]
Employee
Officer
Partner
Employee Director
Are you a current or former Non-Employee Director, Consultant, Contractor or Trustee of any entity you are complaining about? [310]
Yes No
If Yes, Check all that apply. [311]
Non-Employee Director
Consultant
Contractor
Trustee
Firm Name [7]
|
Street Address [11]
|
Address (Continued) [12]
|
Zip / Postal Code [15]
|
City [13]
|
State / Province [14]
|
Country [16]
|
Home Phone [19]
|
Work Phone [20]
|
Mobile Phone [21]
|
Other Phone [22]
|
Email Address [23]
|
Website [24]
|
If the complaint is about an entity or person who has custody or control of your investments, have you had difficulty contacting that entity or person? [36]
Yes No Unknown
Which investment products are involved?
Instructions
From the list below, please select the product involved in your complaint. If you know the ticker symbol or the name of the product, enter it in the spaces provided. Select the type of product involved in your complaint. [182]
Annuities and insurance products
Please select the category that best describes the security product. [183]
Equity-indexed annuities
Fixed annuities
Variable annuities
Viaticals and life settlements
Other insurance products (not annuities)
For other insurance products (not annuities), please provide more information. [184]
|
Banking and consumer finance products
Please select the category that best describes the security product. [183]
Certificates of deposit
Credit cards
Reverse mortgages
Subprime mortgages
Traditional Mortgages
Other banking and consumer finance products
For other banking and consumer finance products, please provide more information. [185]
|
Commodities
Please select the category that best describes the security product. [183]
Coins and precious metals
Currency transactions
Futures
Other commodities
For other commodities, please provide more information. [187]
|
Debt securities (e.g., corporate bonds, municipal bonds)
Please select the category that best describes the security product. [183]
Auction rate securities
High-yield and junk bonds
Investment-grade bonds
Municipal bonds
Promissory notes
Structured note products
Treasury bonds and other U.S. government securities
Other debt securities
For other debt securities, please provide more information. [188]
|
Derivatives (e.g., futures, options, swaps)
Please select the category that best describes the security product. [183]
Collateralized debt obligations and other pooled securities
Credit default swaps or other related agreements
Mortgage-backed securities
Options (calls and puts)
Other asset-backed securities
For other asset-backed securities, please provide more information. [756]
|
Other derivatives
For other derivatives, please provide more information. [189]
|
Equities (e.g., common stock, preferred stock)
Please select the category that best describes the security product. [183]
American Depositary Receipts
Common stock (exchange-traded stock)
Common stock (traded over-the-counter, including microcap and penny stock)
Convertible securities
Preferred shares
Rights and warrants
Unregistered stock
Other equities
For other equities, please provide more information. [190]
|
Funds (e.g., ETFs, mutual funds, private equity funds, hedge funds)
Please select the category that best describes the security product. [183]
529 plans
Exchange-traded funds
Hedge funds
Money-market funds
Mutual funds
Unit investment trusts
Other funds
For other funds, please provide more information. [191]
|
Real Estate
Please select the category that best describes the security product. [183]
Real estate investment trusts
Real estate purchases and sales
Tax-structured real estate transactions (1031 exchanges)
Other real estate investments
For other real estate investments, please provide more information. [192]
|
Retirement accounts and products
Please select the category that best describes the security product. [183]
401(k) plans
Individual retirement accounts
Public pensions
Other retirement plans
For other retirement plans, please provide more information. [193]
|
Other
Please select the category that best describes the security product. [183]
Exempt securities offerings
Franchises and similar business ventures
High-yield investment programs
Partnership investments
Prime bank securities
Unknown
Wrap accounts and separately managed accounts
Other
For other, please provide more information. [194]
|
Enter the ticker symbol, if known. [155]
|
Enter the product name(s). [67]
|
About you
Instructions
The next question asks you whether you are filing this tip under the SEC's Whistleblower Program. Under the SEC's Whistleblower Program:
You may be entitled to receive a whistleblower award. The SEC makes monetary awards to eligible individuals who voluntarily provide original information that leads to successful SEC enforcement actions resulting in monetary sanctions over $1 million and successful related actions. Amounts awarded are between 10-30% of amounts collected in the action.
You are entitled to enhanced confidentiality protections. Although the SEC treats all tips, complaints and referrals as confidential and non-public (and does not disclose such information to third parties, except in limited circumstances authorized by statute, rule, or other provisions of law), the SEC's Whistleblower Program provides additional confidentiality protections, consistent with the limitations and exceptions on disclosure of information that could reasonably be expected to reveal the identity of a whistleblower set forth in Section 21F(h)(2) of the Securities Exchange Act of 1934 and Rule 21F-7 of the SEC's Whistleblower Rules.
You must indicate "yes" to the next question if you wish to receive the enhanced confidentiality protections or to be eligible to receive a whistleblower award.
* Are you filing this tip under the SEC's whistleblower program? [777]
Yes No
If NO to the above, Are you submitting this tip, complaint or referral anonymously? Being able to contact you for further information or clarification may be helpful. [999]
Yes No
If No to being ANONYMOUS, Provide your first name, last name, and at least on form of contact information in the fields below.
If Yes to being ANONYMOUS, Populate the first and last name fields with “ANONYMOUS” and the home telephone field with zeroes.
If you are filing on behalf of another government agency or outside organization, please identify it here. [302]
|
If YES to Are you filing this tip under the SEC's whistleblower program?
In order for a whistleblower who chooses to submit information anonymously (that is, without providing the whistleblower's identity or contact information) to be eligible for an award, the anonymous whistleblower must:
1. Be represented by an attorney;
2. Provide the attorney with a hard copy form TCR that the person has completed and signed under penalty of perjury; and thereafter,
3. Instruct the attorney to submit this electronic form on the person's behalf.
*Are you an attorney filling out this form on behalf of an anonymous whistleblower client who is seeking an award? [201]
Yes No
If Yes, proceed to attorney information.
If No, Provide your first name, last name, and at least one form of contact information in the fields below. Please note that if you choose to be anonymous, and are not represented by an attorney, then you will not be eligible for a whistleblower award, even if you check “yes” to the question regarding whether you wish to be eligible for an award. If you wish to remain anonymous, please enter “ANONYMOUS” in the first name and last name fields and enter all zeros in the home telephone number field. [227]
Title [68]
Mr Mrs Ms
* First Name [73]
|
Middle Name [74]
|
* Last Name [75]
|
Street Address [76]
|
Address (Continued) [77]
|
Zip / Postal Code [81]
|
City [78]
|
State / Province [79]
|
Country [82]
|
Home Telephone [84]
|
Work Telephone [85]
|
Mobile Telephone [164]
|
Other Telephone [86]
|
Email Address [165]
|
What is the best way to reach you? [166]
Email Phone Postal mail
Are you represented by an attorney in connection with this matter, or would you like to provide your attorney's contact information? [202]
Yes No
If YES, Complete the attorney information below.
Select the profession that best represents you. [3]
Accountant
Attorney
Auditor
Broker-Dealer
Compliance Officer
Investment Advisor
Investment Advisor Representative
Investment company director, officer, or employee
Law enforcement personnel (federal, state, or local)
Member of Congress (On behalf of constituent)
Member of Congress (own behalf)
Registered Representative
Student
Transfer Agent
Underwriter
Other
For Other, please specify. [151]
|
Have you reported the matter at issue in this submission to your supervisor, compliance office, whistleblower hotline, ombudsman, or any other available mechanism for reporting possible violations at any entity you are complaining about? [2145]
Yes No
If you answered "Yes," please provide details. [2146]
|
Were you retaliated against for reporting the matter at issue in this submission either internally at the entity or to a regulator?[2147]
Yes No
If you answered "Yes," please provide details. [2148]
|
Has anyone taken steps to prevent you from reporting this violation to the SEC? [2149]
Yes No
If you answered "Yes," please provide details. [2150]
|
If filing as a Whistleblower, with or without an attorney, proceed to the following question: * Are documents or other information being submitted that could potentially identify the whistleblower? [199]
Provide the attorney's name and contact information.[204]
The attorney's name and at least one form of contact information are required.
Attorney Title [47]
Mr Mrs Ms
* Attorney First Name [48]
|
Attorney Middle Name [49]
|
* Attorney Last Name [50]
|
Attorney Firm Name [218]
|
Attorney Street Address [51]
|
Attorney Address (Continued) [52]
|
Attorney Zip / Postal Code [55]
|
Attorney City [53]
|
Attorney State / Province [54]
|
Attorney Country [56]
|
Attorney Work Telephone [59]
|
Attorney Fax Telephone [61]
|
Attorney Email Address [62]
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Has your client reported this matter to his or her supervisor, compliance office, whistleblower hotline, ombudsman, or any other available mechanism for reporting possible violations at any entity that he or she is complaining about? [12151]
Yes No
If you answered "Yes," please provide details. [12152]
|
Has your client been retaliated against for reporting the matter at issue in this submission either internally at the entity or to a regulator? [12153]
Yes No
If you answered "Yes," please provide details. [12156]
|
Has anyone taken steps to prevent your client from reporting this violation to the SEC? [12158]
Yes No
If you answered "Yes," please provide details. [12159]
|
* Are documents or other information being submitted that could potentially identify the whistleblower?[199]
Yes No
* If Yes, Identify with particularity any documents or other information in your submission that you believe could reasonably be expected to reveal your identity.[222]
|
*NOTE: If you would like to be eligible to apply for a whistleblower award in the future if your information leads to a successful enforcement action, you must answer "Yes" to this question, even if you answered "Yes" above. Answering yes to this question will require you to complete the whistleblower declaration/attorney certification at the end of this questionnaire. Please note that even if you check "Yes" to this question, you will still need to complete a whistleblower application for award on Form WB-APP after a successful enforcement action is brought based on your tip. Further, as noted above, if you would like to be eligible to apply for an award and choose to submit your information anonymously, i.e., without providing your identity or contact information, an attorney must complete this form on your behalf and must complete the attorney certification.
* Does the whistleblower want to be eligible to apply for a whistleblower award? [200]
Yes No
If filling out as an attorney, complete the attorney declaration form.
If filling out as the complainant, complete the whistleblower declaration form.
Complete the whistleblower eligibility questions.[111]
For these eligibility questions, “you” refers to the whistleblower. [18]
* 1. Are you, or were you at the time you acquired the original information you are submitting to us, a member, officer or employee of the Department of Justice; the Securities and Exchange Commission; the Comptroller of the Currency; the Board of Governors of the Federal Reserve System; the Federal Deposit Insurance Corporation; the Office of Thrift Supervision; the Public Company Accounting Oversight Board; any law enforcement organization; or any national securities exchange, registered securities association, registered clearing agency, or the Municipal Securities Rulemaking Board? [205]
Yes No
If the answer to the question is "Yes," please provide details. [2055]
|
* 2. Are you, or were you at the time you acquired the original information you are submitting to us, a member, officer, or employee of a foreign government, any political subdivision, department, agency, or instrumentality of a foreign government, or any other foreign financial regulatory authority as that term is defined in Section 3(a)(52) of the Securities Exchange Act of 1934 (15 U.S.C. Section 78c(a)(52))? [206]
Yes No
If the answer to the question is "Yes," please provide details. [2066]
|
* 3. Did you acquire the information being submitted to us through the performance of an engagement required under the federal securities laws by an independent public accountant? [207]
Yes No
If the answer to the question is "Yes," please provide details. [2077]
|
* 4. Are you providing this information pursuant to a cooperation agreement with the SEC or another agency or organization? [208]
Yes No
If the answer to the question is "Yes," please provide details. [2088]
|
* 5. Are you a spouse, parent, child, or sibling of a member or employee of the SEC, or do you reside in the same household as a member or employee of the SEC? [209]
Yes No
If the answer to the question is "Yes," please provide details. [2099]
|
* 6. Have you or anyone representing you received any request, inquiry or demand that relates to the subject matter of your submission (i) from the SEC; (ii) in connection with an investigation, inspection or examination by the Public Company Accounting Oversight Board, or any self-regulatory organization; or (iii) in connection with an investigation by Congress, any other authority of the federal government, or a state Attorney General or securities regulatory authority? [212]
Yes No
If the answer to the question is "Yes," please provide details. [213]
|
* 7. Are you currently a subject or target of a criminal investigation, or have you been convicted of a criminal violation, in connection with the information you are submitting to the SEC? [214]
Yes No
If the answer to the question is "Yes," please provide details. [215]
|
* 8. Did you acquire the information being provided to us from any person described in Questions 1 through 7? [210]
Yes No
If the answer to the question is "Yes," please provide details. [223]
|
* I certify that I have reviewed this form for completeness and accuracy and that the information contained herein is true, correct and complete to the best of my knowledge, information and belief. I further certify that I have verified the identity of the whistleblower on whose behalf this form is being submitted by viewing the whistleblower's valid, unexpired government issued Identification (e.g., driver's license, passport) and will retain an original, signed copy of the Form TCR with the declaration signed by the whistleblower, in my records. I further certify that I have obtained the whistleblower's non-waiveable consent to provide the Commission with his or her original signed Form TCR upon request in the event that the Commission requests it due to concerns that the whistleblower may have knowingly and willfully made false, fictitious, or fraudulent statements or representations, or used any false writing or document knowing that the document contains any false, fictitious or fraudulent statement or entry; and that I consent to be legally obligated to do so within 7 calendar days of receiving such a request from the Commission. [216]
Agree Do not agree
WHISTLEBLOWER DECLARATION
Complete the whistleblower eligibility questions.[111]
For these eligibility questions, “you” refers to the whistleblower. [18]
* 1. Are you, or were you at the time you acquired the original information you are submitting to us, a member, officer or employee of the Department of Justice; the Securities and Exchange Commission; the Comptroller of the Currency; the Board of Governors of the Federal Reserve System; the Federal Deposit Insurance Corporation; the Office of Thrift Supervision; the Public Company Accounting Oversight Board; any law enforcement organization; or any national securities exchange, registered securities association, registered clearing agency, or the Municipal Securities Rulemaking Board? [205]
Yes No
If the answer to the question is "Yes," please provide details. [2055]
|
* 2. Are you, or were you at the time you acquired the original information you are submitting to us, a member, officer, or employee of a foreign government, any political subdivision, department, agency, or instrumentality of a foreign government, or any other foreign financial regulatory authority as that term is defined in Section 3(a)(52) of the Securities Exchange Act of 1934 (15 U.S.C. Section 78c(a)(52))? [206]
Yes No
If the answer to the question is "Yes," please provide details. [2066]
|
* 3. Did you acquire the information being submitted to us through the performance of an engagement required under the federal securities laws by an independent public accountant? [207]
Yes No
If the answer to the question is "Yes," please provide details. [2077]
|
* 4. Are you providing this information pursuant to a cooperation agreement with the SEC or another agency or organization? [208]
Yes No
If the answer to the question is "Yes," please provide details. [2088]
|
* 5. Are you a spouse, parent, child, or sibling of a member or employee of the SEC, or do you reside in the same household as a member or employee of the SEC? [209]
Yes No
If the answer to the question is "Yes," please provide details. [2099]
|
* 6. Have you or anyone representing you received any request, inquiry or demand that relates to the subject matter of your submission (i) from the SEC; (ii) in connection with an investigation, inspection or examination by the Public Company Accounting Oversight Board, or any self-regulatory organization; or (iii) in connection with an investigation by Congress, any other authority of the federal government, or a state Attorney General or securities regulatory authority? [212]
Yes No
If the answer to the question is "Yes," please provide details. [213]
|
* 7. Are you currently a subject or target of a criminal investigation, or have you been convicted of a criminal violation, in connection with the information you are submitting to the SEC? [214]
Yes No
If the answer to the question is "Yes," please provide details. [215]
|
* 8. Did you acquire the information being provided to us from any person described in Questions 1 through 7? [210]
Yes No
If the answer to the question is "Yes," please provide details. [223]
|
* I declare under penalty of perjury under the laws of the United States that the information contained herein is true, correct and complete to the best of my knowledge, information, and belief. I fully understand that I may be subject to prosecution and ineligible for a whistleblower award if, in my submission of information, my other dealings with the SEC, or my dealings with another authority in connection with a related action, I knowingly and willfully make any false, fictitious, or fraudulent statements or representations, or use any false writing or document knowing that the writing or document contains any false, fictitious, or fraudulent statement or entry. [217]
Agree Do not agree
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Knowling, Jennifer (Contractor) |
File Modified | 0000-00-00 |
File Created | 2021-01-15 |