The standard template for filing complaints, as provided by Commission Delegated Regulation (EU) 2025/294 of 1 October 2024 supplementing Regulation (EU) 2023/1114 of the European Parliament and of the Council with regard to regulatory technical standards specifying the requirements, templates and procedures for the handling of complaints by the crypto-asset service providers.
Template for the Filing of Complaints
| FILING OF A COMPLAINT
(to be sent by the Client to the crypto-asset service provider) |
1.a Personal data of the complainant
| Last name/legal entity name | First name | Registration or ID number | LEI (if available) | Client reference (if available) |
| Address: Street, number, floor (for firms registered office) |
Postcode |
City |
Country |
| Telephone |
1.b Contact details (if different from 1.a)
| Last name/Legal entity name | First name |
| Address: Street, number, floor (for firms registered office) |
Postcode |
City |
Country |
| Telephone |
2.a Personal data of the legal representative (if applicable) (a power of attorney or other official document as proof of the appointment of the representative)
| Last name | First name/Legal entity name | Registration number and LEI (if available) |
| Address: Street, number, floor (for firms registered office) |
Postcode | City | Country |
| Telephone |
2.b. Contact details (if different from 2.a)
| Last name/Legal entity name | First name |
| Address: Street, number, floor (for firms registered office) |
Postcode | City | Country |
| Telephone |
- Information about the Complaint
3.a Full reference of the crypto-asset service or agreement to which the Complaint relates (i.e. name of the crypto-asset service provider, crypto-asset service reference number, or other references of the relevant transactions…)
3.b Description of the Complaint’s subject-matter
Please provide documentation supporting the facts mentioned.
3.c Date(s) of the facts that have led to the Complaint
3.d Description of damage, loss or detriment caused (where relevant)
3.e Other comments or relevant information (where relevant)
In _____________(place) on ____________(date)
Signature
Complainant/Legal representative
Documentation provided (please check the appropriate box):
| Power of attorney or other relevant document | |
| Copy of the contractual documents of the investments to which the Complaint relates | |
| Other documents supporting the Complaint: |
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