Action to date

Yes, I have previously lodged or registered this dispute with the ClaimBackXNo, this is the first time I have lodged or registered this dispute with the ClaimBackX

Applicant Details

Bank and Payment Details

"What financial Broker did you use?"

"Broker's website URL?"

"What bank did you use for deposit? Ex: Revolut, Swebank..."

"How much money did you lose in the investment with this broker?"

Dispute Details

Please describe the nature of your complaint.

Please include as much information as you can, including the type of product involved, the dates the problem occurred,
the name, address and telephone number (if you know these) of all individuals and firms involved and a description
of the problem (please attach a separate page if you need more space than provided)

Additional Comments

What do you think is a fair and reasonable resolution to the dispute?

If you are seeking payment of a sum of money please provide any relevant calculations of your claim(s)

Information you don't have to submit:

• Any personal identifiers (ID, driver’s license, passports, etc);

• Financial documents including bank account statements and credit card information;

• Personal account information: login, password, email address.