COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : INSTRUCTIONS FOR COMPLETING THE COMPLAINT FORM SUBPOENA JUDICIAL Plaintiff(s) The New Hampshire Bureau of Securities Regulation is responsible for regulating securities activities -against: in the State of New Hampshire. We oversee the firms and individuals who offer or sell securities or offer investment advice to the public. : Before filling out the complaint form, please take the time to read these instructions. They will help you to understand our functions, and we will be better able to understand and act on your complaint. : WHAT WE CAN DO: Defendant(s) : ........... ................ .......... ....... ...... We investigate. complaints against. individuals, .business .corporations, and other entities for possible violations of the registration, licensing, or anti-fraud provisions of the Revised Statutes Annotated 421-B. We are empowered to bring administrative actions or civil law suits to stop these violations, render sanctions, and, in appropriate cases, to refer matters for criminal prosecution. It is in the public interest to report alleged STATE OF of the YORK THE PEOPLE OF THE violations NEW securities laws, and we encourage you to do so. WHAT WE CANNOT DO: TO We cannot act as a court of law. We cannot order that monies be refunded or that damages be paid. In some instances restitution or rescission is made to investors as a result of this agency's action, but those instances are not the norm. You should not rely on us to get your money back for you. We cannot enforce the Business Corporation Laws, partnership laws, contract laws, or regulate the offer GREETINGS: and sale of annuities. We cannot give legal or financial advice or act as your attorney. WE COMMAND YOU, HOW YOU CAN HELP US: that all business and excuses being laid aside, you and each of you attend before the Honorable at the Court Organizeof located at County your complaint using these guidelines: , separate , want , say. o'clock in feelings from the facts.recessed noon, and at any First, of of 1.in room make a on the listday the things you 20 toat Separate yourthe or adjourned date, toclearly and give evidence as asection to the best of on theability. the testify in ink. Fill out each witness in this action your part of Type or print 2. In this form, specifically question 14, present the events in the order in which they happened, using dates whenever possible. a) Your failureWHAT happened. Start fromisthe beginning.aBe specific as to whatwill make you liable to Tell us to comply with this subpoena punishable as contempt of court and was said the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a and who said it. result b) yourTell us to comply. first learned of the investment opportunity or investment service. of failure HOW you Tell us WHO was present during these conversations or acts. c) Tell us WHEN and WHERE these conversations/acts took place. d) , one of the Justices of the e) Witness,us WHY you decided to take advantage of the investment or investment service. Tell Honorable List the names, addresses,of telephone20 Court f) in County, day and , numbers of any others who you believe may have similar complaints. g) Tell us WHEN and WHERE the money and agreements changed hands. 3. Enclose copies of documents such as stock certificates, bonds, limited partnership agreements, (Attorney must sign above and type name below) prospectuses, confirmations, letters, canceled checks (front and back), advertisements, papers, notes, or other documents that may explain your complaint. Do not send originals; we cannot be responsible for their safekeeping. 4. Remember that your complaint should describe the event or practice which you believe was Attorney(s) for unfair. If possible, you should state why the event or practice was improper. Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com , COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : STEPS YOU CAN TAKE IF YOUR COMPLAINT INVOLVES A BROKER-DEALER: Calendar No. Many disputes with brokerage firms can be directly resolved by your doing the following: : JUDICIAL SUBPOENA Plaintiff(s) NOTIFY YOUR BROKER AND YOUR BROKER'S MANAGER -against- : 1. Talk to your salesperson about the problem. 2. Negotiate directly with your salesperson to resolve the matter. Frequently, minor issues can be settled informally at this point. : : If you feel the salesperson has answered your questions unsatisfactorily or is unwilling to Defendant(s) : . . . . .review your.complaint, .contact . . . .salesperson's . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . the . . . . . . . . . . . supervisor, as well as the office manager. 3. 4. Write to the firm's chief compliance officer. This individual is located at the firm's home office address. Request a response in writing from the compliance officer. (You can get the name of the compliance officer and the firm's home address from the broker's office.) THE PEOPLE OF THE STATE OF NEW YORK ARBITRATION PROCEDURES TO The United States Securities and Exchange Commission has approved certain arbitration procedures for resolution of disputes between investors and broker-dealers. Arbitration is a method of having a dispute between two or more parties resolved by an impartial person who is knowledgeable in the areas of controversy. Arbitration generally is quicker and less expensive than using the courts to resolve a complaint. Because of this, arbitration has long been used as an alternative to the courts. Once the GREETINGS: arbitrator has made a decision, the decision is final and is subject to review by a court only on a very limited basis. Also, if arbitration is chosen as a means of resolving a dispute, the complaining party WE COMMAND the matter through the courts. gives up the right to pursue YOU, that all business and excuses being laid aside, you and each of you attend before the Honorable at the Court Further, based upon the contract enteredat between you and your broker, you may be obligated to located into County of submit the dispute to arbitration in lieu of litigation through the courts. in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, toin learning give evidencethe a witness in process, you canpart of the National testify and more about as arbitration this action on the contact the If you are interested Association of Securities Dealers (NASD) or the New York Stock Exchange (NYSE) with which your broker-dealer is a member. The address for the NYSE and the NASD are: Your failure to complyExchangesubpoena is punishable as a contempt of court and will make you liable to New York Stock with this National Association of Securities Dealers, Inc. 11 Wall Street the party on whose behalf this subpoena was issued for a33 Whitehall Street $50 and all damages sustained as a maximum penalty of New York, NY 10004 result of yourNew York, NY 10005 failure to comply. Telephone: (212) 656-3000 Telephone: (212) 480-4881 , one of the Justices of the If you haveWitness, Honorable any questions concerning this form, you may call the New Hampshire Bureau of Securities Regulation at (603)271-1463, between 8:00 a.m. and ,4:30 p.m. Court in County, day of 20 Upon completion of all sections, please mail the complaint form along with copies of any supporting documents to: (Attorney must sign New Hampshire Bureau of Securities Regulation above and type name below) State House Room 204 Concord NH 03301-4989 (603) 271-1463 Attorney(s) for PLEASE NOTE: As part of the complaint handling process, the Bureau may send a copy of this form to the broker-dealer firm against whom your complaint is filed. Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com , COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. State of New Hampshire Department of State : Calendar No. Bureau of Securities Regulation : Plaintiff(s) -againstMailing Address State House, Room 204 Concord New Hampshire 03301-4989 JUDICIAL SUBPOENA : Location State House Annex 25 Capitol St. Concord, New Hampshire 03301 : : TTY/TDD Relay (603) 225-4033 Defendant(s) : ...................................................... COMPLAINT FORM THE PEOPLE OF THE STATE OF NEW YORK TO We appreciate your interest and will proceed with a preliminary investigation as soon as this form is returned, along with any documentary evidence that you may have. Please remember to attach a copy of any written materials (i.e. checks, contracts, advertisements, letters, etc.) that may relate to your complaint GREETINGS: WE COMMAND I. Personal Information YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located FIRST at County ofNAME LAST MIDDLE CURRENT DATE in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the HOME ADDRESS CITY STATE ZIP PHONE NO. BUSINESS ADDRESS CITY STATE ZIP PHONE NO. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was BIRTH for a maximum penalty of $50 and all damages sustained as a issued TRADE/OCCUPATION MARITAL STATUS DATE OF result of your failure to comply. II. Basis of Complaint Witness, Honorable , one of the Justices of the 1. With what company, corporation, or association did you invest Court in County, day of , 20 PHONE NO. NAME (Attorney must sign above and type name below) ADDRESS CITY STATE 2. List person(s) involved in this transaction: LAST NAME ADDRESS LAST NAME ADDRESS FIRST CITY FIRST CITY ZIP Attorney(s) for MIDDLE STATE POSITION PHONE NO. Office and P.O. Address ZIP Telephone MIDDLE No.: Facsimile No.: STATE E-Mail Address: ZIP Mobile Tel. No.: POSITION PHONE NO. American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. 3. How did you learn of the investment? (check more than one, if necessary) Personal Visit Telephone Call : Sales Letter Calendar No. Radio : JUDICIAL SUBPOENA Plaintiff(s) Newspaper Television Phone Book -against: Other (please explain) Presentation : 4. In what did you purchase or invest (e.g. common stock, promissory note, mutual fund, limited partnership interest, T-bond, investment contract, fractional interest : in an oil and gas lease)? Defendant(s) : ...................................................... Advertisement 5. How many units did you purchase? THE PEOPLE OF THE STATE OF NEW YORK 6. What was the total amount of your investment? $ 6a. Please state whether payment was made with cash, check, or charge and enclose a TO copy of your receipt. 7. On what date was the investment made? 8. Did you sign any contract or receive any document to evidence your investment? If yes, please enclose a copy. Yes No GREETINGS: 9. List any oral representations made to you by the agent/salesperson. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 10. Did you receive an offering circular or prospectus? If yes, please enclose a Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to copy. Yes No the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. present when you invested or were solicited to invest ? 11. Was any other person(s) If yes, please list Yes No Witness, Honorable , one of the Justices of the Court in County, day of , 20 Name Address Phone No. (Attorney must sign above and type name below) Name Address Phone No. 12. Do you know of any other person who invested in the company, corporation, or association? No If yes, please list Attorney(s) for Yes Name Name Phone No. Address Address Office and P.O. Address Phone No. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 13. Have you notified or filed a complaint with any of Index following? the No. Private Attorney : Calendar No. : JUDICIAL SUBPOENA Consumer Protection Division Better Business Bureau Plaintiff(s) Local Police Department -against: U.S. Securities and Exchange Commission (SEC) : Local Newspaper U.S. Attorney's Office : Federal Bureau of Investigation Defendant(s) : . .National . . . . . . . . . . . . . . . .of . Securities . Dealers. .(NASD) . . . . . . . . . Association . . . . . . . . . . . . . . . . . . . . . . . THE summarization of allegations and complaint: 14. Brief PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the (Please be sure to attach all documentation received in connection to the transaction.) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your that comply. I hereby certifyfailure to the above information is true and correct to the best of my knowledge. Witness, Honorable Court in County, Signature , one of the Justices of the day of , 20 Date (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com