About your complaint
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dd/mm/yy
Today’s date
Date when issue arose
Date when you first became
aware of the circumstances
giving rise to your complaint
Do you want to authorise
another person to act on
your behalf?
If so, please provide their
name and contact details,
including email address.
(You can change this at any
point by contacting us)
Your circumstances
Have you made a complaint
to the regulators before (FCA/
PRA/Bank of England)? If so,
please tell us the reference
number(s) assigned to your
case(s)
Do you have a disability or
any practical needs where we
(the FCA) could help by
making adjustments, for
example using large print,
braille or a different language?
Tell us about your complaint about us. What happened?
How have you been affected by the FCA's actions - financially or otherwise?
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