Form

Complaint form BTC Direct Europe B.V.

Please fill in the complaint form with the details of your complaint as completely as possible, so that we can assist you in the best possible way. The fields marked with an * are mandatory.

The data you enter in this form will be processed in accordance with the privacy policy of BTC Direct.

Personal data

My complaint relates to*

my Private account

my business account

First name/ Name of legal entity *

Surname*

Registration- or ID-nummer*

The document number of your passport or ID card.

Street and house number*

Floor

(If applicable)

Postal code*

City*

Country*

Phone number*

🇺🇸

Email address*

Of your BTC Direct account

Alternative contact information?*

Yes

Is a legal representative involved?*

Yes

Alternative data (If applicable)

Legal representative information (If applicable)

Information regarding the complaint

Description of the subject of the complaint*

Please provide documentation that supports the stated facts.*

Date(s) of the facts that led to the complaint*

Description of the damage or loss caused (if applicable)

Other comments or important information (if applicable)

Signature

City*

on*

Date (dd-mm-yyyy)

Name - Signature*

Included documentation*

Check box which are applicable

Power of attorney or other relevant document

Copy of the contractual documents of the investments subject to the complaint

Other documents in support of the complaint