Fillable Form 30 - With OMB Control No. Feb 2018 CFTC Reparations Complaint Form

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Form 30 - With OMB Control No. Feb 2018 CFTC Reparations Complaint Form

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Commodity Futures Trading Commission
Reparations Complaint
Form
If the space provided on this form is not sufficient, attach your own supplementary sheets containing the required information. This
form must be typed or printed legibly. Note: Fill out both sides completely.
1. COMPLAINANT’S NAME TEL.NO. (Home) TEL. NO (Work) FAX NO. EMAIL ADDRESS
ADDRESS (Street) (City) (State) (ZIP)
COMPLAINANT’S NAME TEL. NO. (Home) TEL. NO (Work) FAX NO. EMAIL ADDRESS
ADDRESS (Street) (City) (State) (ZIP)
2. Registered persons and/or firms you think violated the Commodity Exchange Act
RESPONDENT’S NAME TEL. NO. FAX NO. EMAIL ADDRESS
ADDRESS (Street) (City) (State) (ZIP)
Was this individual/firm registered with the CFTC at the time of the alleged violation? YES NO
RESPONDENT’S NAME TEL. NO. FAX NO. EMAIL ADDRESS
ADDRESS (Street) (City) (State) (ZIP)
Was this individual/firm registered with the CFTC at the time of the alleged violation? YES NO
RESPONDENT’S NAME TEL. NO. FAX NO. EMAIL ADDRESS
ADDRESS (Street) (City) (State) (ZIP)
Was this individual/firm registered with the CFTC at the time of the alleged violation? YES NO
3. If known, cite the specific portions of the Act, rules or regulations violated:
4. Description of complaint. Describe in detail, giving names, dates and the facts which will show how the Commodity Exchange Act was violated
and how you were injured by that violation. You must set forth this information on supplementary sheets which you must attach to this complaint
form.
5. Amount of damages claimed. You must include an explanation of how you calculated the damages you have claimed.
6. Have you brought another action based on the same set of facts in an arbitration forum or civil court? YES NO
7. If yes, has the case been decided? YES NO
8. To your knowledge, are any of the respondents you named the subject of an ongoing receivership or
bankruptcy proceedings? YES NO
YOU MUST ALSO COMPLETE THE BACK OF THIS FORM
CFTC Form 3
0 (Rev.
2/18)
Previous editions are obsolete
OMB Control No.
3038-0115
Important: You must enclose the total amount of the filing fee for the type of decisional procedure you select or your
complaint will not be processed. Please indicate the procedure you select and enclose a check or money order made payable to the
Commodity Futures Trading Commission in the total amount. The filing fee must accompany your complaint. (See attached Notice
to Customers Making Payment by Check) Under no circumstances will the filing fee be refunded. CHECK ONE:
$50 Voluntary Decisional Procedure. T
his procedure entitles you, if the respondents agree, to present your case in written
form before a CFTC judgment officer. A final decision will be issued without explanation of the reasons. By electing the voluntary
procedure, you will waive your right to appeal as well as prejudgment interest and costs. Post-judgment interest may be awarded if
you prevail.
$125 Summary Decisional Procedure. I
f your claim is $30,000 or less, it can be heard by a judgment officer. You may
present your case in written form, and if deemed necessary by the judgment officer, orally, in Washington, or by telephone under this
procedure. The judgment officer will issue brief statements of factual findings and conclusions based on law which are appealable
first to the Commission and from there to a U.S. Court of Appeals. Prejudgment and post-judgment interest may be awarded if you
prevail.
$250 Formal Decisional Procedure. I
f your claim is over $30,000, it can be assigned to an administrative law judge (ALJ) for
a formal hearing. You may present your case in written form. If oral testimony is deemed necessary by the ALJ, you may be required
to travel up to 300 miles to attend the hearing. The ALJ will issue findings of fact and conclusions of law which are appealable first to
the Commission and from there to a U.S. Court of appeals. Prejudgment and post-judgment interest may be awarded if you prevail.
Notice: Filing fees, once paid to the Commodity Futures Trading Com
mission, are not refundable. Verify that the person or
persons named in the complaint were registered with the CFTC at this time of the alleged offense. Call (202) 418-5506 for
registration information. If individuals named in the complaint were registered, send the complaint form and check for the
filing fee made payable to the Commodity Futures Trading Commission to: Proceedings Clerk, 1155 21
st
Street, N.W.,
Washington, D.C. 20581.
VERIFICATION
I hereby swear or affirm (under penalty of law) that the facts set forth in this complaint are known to be true or, based on my
best information, are believed to be true. To the extent that any facts are believed, instead of known, to be true, the information upon
which I formed that belief is set forth as follows (attach detailed, specific information on a supplementary sheet):
Each complainant must sign:
Complainant’s signature Date
Complainant’s signature Date
Notary Date
PRIVACY AC
T NOT
ICE: The Commission’s authority for soliciting this information is granted in 7 U.S.C. § 18 and Part 12 of the
Commission’s regulations. The information on this form is primarily used by the Commission’s Office of Proceedings to determine if
the complaint is sufficiently complete for further processing and to initiate and move forward a reparations proceeding. Information
contained in the form and complaint may be used by the Commission during any and all phases of a reparations case including, but not
limited to, discovery, litigation, appeals and in written opinions and orders. Information provided may be made public in accordance
with provisions of the CEA and other applicable laws. Under “open government” principles and rules, the Commission generally posts
final reparations and appellate decisions to its public website, which may result in the decisions being captured and displayed through
Internet search engines. The information may also be disclosed to other government agencies or CFTC divisions, for example the
Division of Enforcement, to meet their responsibilities assigned to them by law. It will be maintained and additional disclosures may
be made in accordance with CFTC System of Records Notices, e.g., CFTC-3, Docket Files for Reparations and Administrative
Adjudication and CFTC-29, Reparations Cases Closed in the Complaints Section, available on
http://www.cftc.gov/Transparency/PrivacyOffice/SORN/index.htm
. If you do not provide the requested information, the Office of
Proceedings may not be able to process your complaint.
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Form 30 - With OMB Control No. Feb 2018 CFTC Reparations Complaint Form

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Completed 10 July 2020

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