Information Reporting Form

In carrying out its regulatory and enforcement responsibilities under the Commodity Exchange Act, the Commodity Futures Trading Commission relies upon the public as an important source of information. This form has been prepared by the CFTC's Division of Enforcement to assist members of the public in reporting suspicious activities or transactions which may involve the trading of commodity futures contracts or commodity options.

Please note that the form boxes will expand so your answers can be as long as necessary. The more detail you provide to us, the more useful it will be to the Division of Enforcement.

When you have completed the form, send it to us electronically by selecting Submit at the end of the form or you can mail it to the Division of Enforcement, CFTC, 1155 21st Street, NW, Washington, DC 20581.

Please note that this is not a Reparations complaint form. If you want information about filing a Reparations complaint, please see the Reparations program.

1. Please describe the activity or transaction which is of concern to you:

2. Please identify any firm(s) or individual(s) involved in the activity or transaction and, if you know, the mailing address and telephone number of each such firm or individual:

3. Please identify what, if any, sales literature or other materials you received, either in person, through the mails or electronically:

4. Please describe how and when you learned about the activity or transaction of concern to you:

5. If you became a customer or client of the firm or individual in question, please describe the nature and the current status of your investment. Please include the amount of any profits or losses, and the period of time any account which you opened was active:

6. Please list all relevant Internet addresses if any of the firms or individuals involved in the activity or transaction in question:
(a) maintained email addresses or websites,
(b) posted messages on investment-related bulletin boards, or
(c) participated in investment-related chat rooms

7. Please add whatever other information you believe may be helpful to the Commission:

Your Full Name:

Your Email Address:

Your Mailing Address:

Your Phone Number:

PRIVACY ACT STATEMENT
5 USC 552a

The Commodity Futures Trading Commission has the authority to collect information and evidence pertinent to the effective enforcement of the Commodity Exchange Act and the Commission's regulations. 7 USC 2, 5, 9, 12(a), 13a-1, 15. It may also collect information and evidence relating to futures and options matters on behalf of foreign authorities. 7 USC 16(f)(1).

The Commission's principal reason for soliciting this information through this website is to monitor and/or enforce compliance with the Commodity Exchange Act and CFTC regulations, or to assist foreign authorities in gathering information relevant to their responsibilities. There are no direct effects or sanctions for failing to provide any or all of the requested information. Providing information is completely voluntary.

Any information you do provide, however, must be truthful. A person who is found to have knowingly and willfully submitted false, fictitious, and/or fraudulent statements to the Commission may be fined up to $10,000 and/or imprisoned up to five years for such conduct. 18 USC 1001; 17 CFR 11.6(b).

The information you provide may be used in the routine operation of the Commission, which includes law enforcement, review of legislative and regulatory proposals, regulation of the commodity futures markets, and review of reports and documents filed with the Commission. Specifically, the Commission may use the information obtained from this form in any administrative or civil proceeding in which it is a party, or in which any member of the Commission or its staff participates as a party. It may also provide the information to other state and federal agencies, and foreign authorities.

Last Updated: August 1, 2007