ANNEX
Template that issuers of asset-referenced tokens and, where applicable third-party entities, shall make available to holders of asset-referenced tokens the submission of complaints
SUBMISSION OF A COMPLAINT
1.a. Information about the complainant
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LAST NAME/LEGAL ENTITY NAME |
FIRST NAME |
REGISTRATION NUMBER |
LEGAL ENTITY IDENTIFIER (IF AVAILABLE) |
CUSTOMER REFERENCE (IF AVAILABLE) |
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ADDRESS: STREET, NUMBER, FLOOR (In case of legal entity, address of registered office) |
POSTCODE |
CITY |
COUNTRY |
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TELEPHONE |
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EMAIL ADDRESS |
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1.b. Contact details (if different from 1.a)
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LAST NAME/LEGAL ENTITY NAME |
FIRST NAME |
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ADDRESS: STREET, NUMBER, FLOOR (In case of legal entity, address of registered office) |
POSTCODE |
CITY |
COUNTRY |
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TELEPHONE |
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EMAIL ADDRESS |
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2.a. Information about the legal representative (if applicable) (a power of attorney or other official document as proof of the appointment of the representative)
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LAST NAME/LEGAL ENTITY NAME |
FIRST NAME |
REGISTRATION NUMBER |
LEGAL ENTITY IDENTIFIER (IF AVAILABLE) |
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ADDRESS: STREET, NUMBER, FLOOR (In case of legal entity, address of registered office) |
POSTCODE |
CITY |
COUNTRY |
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TELEPHONE |
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EMAIL ADDRESS |
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2.b. Contact details (if different from 2.a)
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LAST NAME/LEGAL ENTITY NAME |
FIRST NAME |
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ADDRESS: STREET, NUMBER, FLOOR (In case of legal entity, address of registered office) |
POSTCODE |
CITY |
COUNTRY |
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TELEPHONE |
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EMAIL ADDRESS |
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3. Information about the complaint
3.a. Full reference of the issuance, offer or seeking of admission to trading of an asset-referenced tokens or agreement to which the complaint relates (i.e. name of the issuers of asset-referenced tokens, Asset-Referenced Tokens reference number, or other references of the relevant transactions…)
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3.b. Description of the complaint’s subject-matter
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Please provide any documentation supporting the facts mentioned.
3.c. Date(s) of the facts that have led to the complaint
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3.d. Description of damage, loss or detriment caused (where relevant)
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3.e. Other comments or relevant information (where relevant)
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In … (place), on… (date)
Signature:
COMPLAINANT/LEGAL REPRESENTATIVE
Documentation provided (please check the appropriate box):
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Power of attorney or other relevant document |
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Copy of the contractual documents of the investments to which the complaint relates |
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Other documents supporting the complaint: |
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ELI: http://data.europa.eu/eli/reg_del/2025/293/oj
ISSN 1977-0677 (electronic edition)