Comparison (redline) doc for TCR

UNITED STATES
COMMODITY FUTURES TRADING COMMISSION
Washington, DC 20581

OMB APPROVAL
OMB Number:
Expires:

3038-0082
10/31/14

FORM TCR
TIP, COMPLAINT OR REFERRAL

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A. TELL US ABOUT YOURSELF
COMPLAINANT 1:
1. Last Name

First Name

M.I.

2. Street Address

Apartment/Unit #

City

State/Province

ZIP/Postal Code

Country

3. Telephone

Alt. Phone

E-mail Address

Preferred Method of
Communication

4. Occupation

COMPLAINANT 2:
1. Last Name

First Name

M.I.

2. Street Address

Apartment/Unit #

City

State/Province

ZIP/Postal Code

Country

3. Telephone

Alt. Phone

E-mail Address

Preferred Method of
Communication

4. Occupation

Please be advised that pursuant to 5 CFRC.F.R. § 1320.5(b)(2)(i), you are not required to respond to this collection of
information unless it displays a currently valid OMB control number.

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B. YOUR ATTORNEY’S INFORMATION (If Applicable – See Instructions)
1. Attorney’s Name

2. Firm Name

3. Street Address

City

State/Province

ZIP/Postal Code

4. Telephone

Fax

E-mail Address

Country

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C. TELL US WHO YOU ARE COMPLAINING ABOUT
INDIVIDUAL/ENTITY 1:
1. Type:

Individual

Entity

If An Individual, Specify Profession.an individual, specify profession. If An Entity,
Specify Typean entity, specify type.

2. Name

3. Street Address

Apartment/Unit #

City

State/Province

4. Telephone

E-mail Address

ZIP/Postal Code

Country

Internet Address

INDIVIDUAL/ENTITY 2:
1. Type:

Individual

Entity

If An Individual, Specify Profession.an individual, specify profession. If An Entity,
Specify Typean entity, specify type.

2. Name

3. Street Address

Apartment/Unit #

City

State/Province

4. Telephone:

E-mail Address:

ZIP/Postal Code

Country

Internet Address:
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D. TELL US ABOUT YOUR COMPLAINT
1. Occurrence Date (mm/dd/yyyy)

2. Nature of Complaint

3a. Type of Financial Product or Investment, if Applicable

3b. Name of Financial Product or Investment, if Applicable

4. State in detail all facts pertinent to the alleged violation. Explain why you believe the facts described constitute a violation of
the Commodity Exchange Act. Use additional sheets, if necessary.

5. Describe all supporting materials in your possession and the availability and location of any additional supporting materials not
in your possession. Use additional sheets, if necessary.

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6. Describe how and from whom you obtained the information that supports your allegations. If any information was obtained
from an attorney or in a communication where an attorney was present, identify such information with as much particularity as
possible. In addition, if any information was obtained from a public source, identify the source with as much particularity as
possible. Use additional sheets, if necessary.

7. Identify with particularity any documents or other information in your submission that you believe could reasonably be expected
to reveal your identity and explain the basis for your belief that your identity would be revealed if the documents or information
were disclosed to a third party.

8a. Have you or your attorney had any prior communication(s) with the CFTC concerning this matter? YES

NO

8b. If the answer to 8a is “Yes,” name ofplease identify the CFTC staff member(s) with whom you or your attorney communicated.

9a. Have you or your attorney provided the information to any other agency or organization, or has any other agency or
organization requested the information or related information from you? YES
NO
9b. If the answer to 9a is “Yes,” please provide details. Use additional sheets, if necessary.

9c. NameIf the answer to 9a is “Yes,” please provide the name and contact information forof the point of contact at the other
agency or organization, if known.

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10a. Does this complaint relate to an entity of which you are or were an officer, director, counsel, employee, consultant or
contractor? YES
NO
10b. If the answer to questionQuestion 10a is “Yes,” have you reported this violation to your supervisor, compliance office,
whistleblower hotline, ombudsman, or any other available mechanism at the entity for reporting violations? YES
NO
10c. If the answer to questionQuestion 10b is “Yes,” please provide details. Use additional sheets, if necessary.

10d. Date on which you took the action(s) described in questionQuestion 10b (mm/dd/yyyy):

11a. Have you taken any other action regarding your complaint? YES

NO

11b. If the answer to questionQuestion 11a is “Yes,” please provide details. Use additional sheets, if necessary.

12. Provide any additional information that you think may be relevant.

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E. WHISTLEBLOWER ELIGIBILITY REQUIREMENTS AND OTHER INFORMATION

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1. Are you currently, or were you at the time that you acquired the original information that you are submitting to the
CommissionCFTC, a member, officer or employee of the Department of Justice, the Commodity Futures Trading Commission, the
Comptroller of the Currency,: the CFTC; the Board of Governors of the Federal Reserve System,; the Office of the Comptroller of
the Currency; the Board of Directors of the Federal Deposit Insurance Corporation,; the Director of the Office of Thrift
Supervision,; the National Credit Union Administration, Board; the Securities and Exchange Commission,; the Department of
Justice; a registered entity,; a registered futures association,; a self-regulatory organization,; a law enforcement organization; or
anya foreign regulatory authority or law enforcement organization?
YES
NO
2. Are you providing this information pursuant to a cooperation agreement with the Commodity Futures Trading
CommissionCFTC or another agency or organization?
YES
NO
3. AreBefore you providingprovided this information before, did you (or anyone representing you) receivedreceive any request,
inquiry or demand that relates to the subject matter of this submission (i) from the Commodity Futures Trading CommissionCFTC,
(ii) in connection with an investigation, inspection or examination by any registered entity, registered futures association or selfregulatory organization, or (iii) in connection with an investigation by the Congress, or any other federal or state authority?
YES

NO

4. Are you currently a subject or target of a criminal investigation, or have you been convicted of a criminal violation, in
connection with the information that you are submitting to the Commodity Futures Trading CommissionCFTC?
YES

NO

5. Are you, or were you at the time you acquired the original information that you are submitting to the Commission, a member,
officer or employee of a foreign regulatory authority or law enforcement organization?
YES

NO

65. Did you acquire the information being provided to usthe CFTC from any person described in questionsQuestions 1 through 54
above?
YES

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NO

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7. Use this space6. If you answered “Yes” to provide additional details relating your responses to questionsany of Questions 1
through 65 above., please provide details. Use additional sheets, if necessary.

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F. WHISTLEBLOWER’S DECLARATION
I declare under penalty of perjury under the laws of the United States that the information contained herein is true, correct and
complete to the best of my knowledge, information and belief. I fully understand that I may be subject to prosecution and ineligible
for a whistleblower award if, in my submission of information, my other dealings with the Commodity Futures Trading
Commission, or my dealings with another authority in connection with a related action, I knowingly and willfully make any false,
fictitious or fraudulent statements or representations, or use any false writing or document knowing that the writing or document
contains any false, fictitious or fraudulent statement or entry.
Print Name

Signature

Date

G. COUNSEL CERTIFICATION

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I certify that I have reviewed this form for completeness and accuracy and that the information contained herein is true, correct and
complete to the best of my knowledge, information and belief. I further certify that I have verified the identity of the whistleblower
on whose behalf this form is being submitted by viewing the whistleblower’s valid, unexpired government issued identification
(e.g., driver’s license, passport) and will retain an original, signed copy of this form, with Section F signed by the whistleblower, in
my records. I further certify that I have obtained the whistleblower’s non-waivable consent to provide the Commodity Futures
Trading Commission with his or her original signed Form TCR upon request in the event that the Commodity Futures Trading
Commission requests it due to concerns that the whistleblower may have knowingly and willfully made false, fictitious or
fraudulent statements or representations, or used any false writing or document knowing that the writing or document contains any
false, fictitious or fraudulent statement or entry; and that I consent to be legally obligated to do so within seven (7) calendar days of
receiving such a request from the Commodity Futures Trading Commission.

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Print Name of Attorney and Law Firm, if Applicable

Signature

Date

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Privacy Act Statement
This notice is given under the Privacy Act of 1974. The Privacy Act requires that the Commodity Futures
Trading Commission (CFTC or Commission) inform individuals of the following when asking for information. The
solicitation of this information is authorized under the Commodity Exchange Act, 7 U.S.C. § 1 et seq. This form may be
used by anyone wishing to provide the CFTC with information concerning a violation of the Commodity Exchange
Act or the Commission’sCFTC’s regulations. If an individual is submitting this information for the
Commission’sCFTC’s whistleblower award program pursuant to Section 23 of the Commodity Exchange Act, the
information provided will be used to enable the CommissionCFTC to determine the individual’s eligibility for payment
of an award. This information will be used to investigate and prosecute violations of the Commodity Exchange Act
and Commissionthe CFTC’s regulations. This information may be disclosed to Federalfederal, state, local or foreign
agencies or other authorities responsible for investigating, prosecuting, enforcing or implementing laws, rules or
regulations implicated by the information consistent with the confidentiality requirements set forth therein, including
pursuant toin Section 23 of the Commodity Exchange Act and Part 165 of the Commission’sCFTC’s regulations. The
information will be maintained and additional disclosures may be made in accordance with System of Records
Notices CFTC-49, “Whistleblower Records” (exempted), CFTC-10, “Investigatory Records” (exempted), and
CFTC-16, “Enforcement Case Files.” Furnishing the information is voluntary. However, if an individual is
providing information for the whistleblower award program, not providing required information may result in the
individual not being eligible for award consideration.
Questions concerning this form may be directed to: Commodity Futures Trading Commission, Whistleblower
Office, Three Lafayette Centre, 1155 21st Street, N.W.,NW, Washington, DC 20581.

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Submission Procedures


If you are submitting information for the Commission’sCFTC’s whistleblower award program, you must
submit your information using this Form TCR.



You may submit this form electronically, through the web portal found on the Commission’sCFTC’s website at
http://www.cftc.gov. You may also print this form and submit it by mail to: Commodity Futures Trading
Commission, Whistleblower Office, Three Lafayette Centre, 11511155 21st Street, N.W.,NW, Washington,

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DC 20581, or by facsimile to (202) 418-5975.
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

You have the right to submit information anonymously. However, in order to receive a whistleblower
award, you will need to be identified to selected Commissionselect CFTC staff for a final eligibility
determination, and in unusual circumstances, you may need to be identified publicly for trial. You should
therefore provide some means for the Commission’sCFTC’s staff to contact you, such as a telephone
number or an e-mail address.
Instructions for Completing Form TCR

General
All references to “you” and “your” are intended to mean the whistleblower.
Section A: Tell Us About Yourself
Questions 1-4: Please provide the following information about yourself:


Lastlast name, first name and middle initial;



Completecomplete address, including city, state and zip code;



Telephonetelephone number and, if available, an alternate number where you can be reached;



Youryour e-mail address (to facilitate communications, we strongly encourage you to provide
youran e-mail address, especially if you are filing anonymously);



Youryour preferred method of communication; and



Youryour occupation.

Section B: Your Attorney’s Information
Complete this section only if you are represented by an attorney in this matter.
Questions 1-4: Provide the following information about your attorney:


Attorney’sattorney’s name;



Firmfirm name;



Completecomplete address, including city, state and zip code;



Telephonetelephone number and fax number; and



Ee-mail address.

Section C: Tell Us Who You Are Complaining About
Question 1:

Choose one of the following that best describes the individual’s profession or the type of entity to
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which your complaint relates:

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

For Individuals: accountant, analyst, associated person, attorney, auditor, broker, commodity
trading advisor, commodity pool operator, compliance officer, employee, executing broker,
executive officer or director, financial planner, floor broker, floor trader, trader, unknown or
other (specify).



For Entities: bank, commodity trading advisorpool, commodity pool operator,
commodity pooltrading advisor, futures commission merchant, hedge fund, introducing
broker, major swap participant, retail foreign exchange dealer, swap dealer, unknown or
other (specify).

Questions 2-4: For each individual and/or entity, provide the following information, if known:


Fullfull name;



Completecomplete address, including city, state and zip code;



Telephonetelephone number;



Ee-mail address; and



Internetinternet address, if applicable.

Section D: Tell Us About Your Complaint
Question 1:

State the date (mm/dd/yyyy) that the alleged conduct occurred or began.

Question 2:

Choose the following option that you believe best describes the nature of your complaint. If you
are alleging more than one violation, please list all that you believe may apply.:


Thefttheft/misappropriation;



Misrepresentationmisrepresentation/omission (i.e., false/misleading marketing/sales literature;
inaccurate, misleading or non-disclosure by commodity pool operator, commodity trading
advisor, futures commission merchant, introducing broker, retail foreign exchange
dealer, major swap participant, swap dealer or their associated person(s); false/material
misstatements in any report or statement);



Ponziponzi/pyramid scheme;



Offoff-exchange foreign currency, commodity or precious metal fraud;

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

Registrationregistration violations (including unregistered commodity pool operator,
commodity trading advisor, futures commission merchant, introducing broker, retail
foreign exchange dealer, swap dealer or their associated person(s));



Tradingtrading (after hours trading, algorithmic trading, disruptive trading, front running,
insider trading, manipulation/attempted manipulation of commodity prices, market timing,
inaccurate quotes/pricing information, program trading, trading suspensions or volatility);



Feesfees/mark-ups/commissions (excessive, unnecessary or unearned administrative,
commission or sales fees; failure to disclose fees; insufficient notice of change in fees; excessive
or otherwise improper spreads or fills);



Salessales and advisory practices (background information on past violations/integrity; breach of
fiduciary duty/responsibility; churning/excessive trading; cold calling; conflict of interest; abuse
of authority in discretionary trading; failure to respond to client, customer or participant;
guarantee against loss; promise to profit; high pressure sales techniques; instructions by client,
customer or participant not followed; investment objectives not followed; solicitation methods
(e.g., cold calling, seminars));



Customercustomer accounts (unauthorized trading); identity theft affecting account; inaccurate
valuation of Net Asset Value; or



Otherother (analyst complaints, market maker activities, employer/employee disputes or other
(specify)).

Question 3a:

Choose from the following the option that you believe best describes the type of financial product
or investment at issue, if applicable:

Question 3b:



 Commoditycommodity futures;



 Optionsoptions on commodity futures;



 Commoditycommodity options;



 Foreignforeign currency transactions;



 Swapsswaps; or



 Otherother (specify).
Provide the name of the financial product or investment, if applicable.

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Question 4:

State in detail all the facts pertinent to the alleged violation. Explain why you believe the facts
described constitute a violation of the Commodity Exchange Act.

Question 5:

Describe all supporting materials in your possession, custody or control, and the availability and
location of additional supporting materials not in your possession, custody or control.

Question 6:

Describe how you obtained the information that supports your allegations. If any information was
obtained from an attorney or in a communication where an attorney was present, identify such
information with as much particularity as possible. In addition, if any information was obtained
from a public source, identify the source with as much particularity as possible.

Question 7:

You may use this space to identifyIdentify any documents or other information in your submission
on this Form TCR that you believe could reasonably be expected to reveal your identity. Explain
the basis for your belief that your identity would be revealed if the documents or information were
disclosed to a third party.

Question 8a:

State whether you or your attorney have had any prior communicationscommunication(s) with the
CommissionCFTC concerning this matter.

Question 8b:

If the answer to questionQuestion 8a is yes, provideidentify the name of the CommissionCFTC
staff member(s) with whom the you or your attorney communicated.

Question 9a:

Indicate whether you or your attorney have provided the information you are providing to the
CommissionCFTC to any other agency or organization, or whether any other agency or
organization has requested the information or related information from you.

Question 9b:

If the answer to questionQuestion 9a is yes, provide details.

Question 9c:

ProvideIf the answer to Question 9a is yes, provide the name and contact information of the point
of contact at the other agency or organization, if known.

Question 10a:

Indicate whether your complaint relates to an entity of which you are, or were in the past, an
officer, director, counsel, employee, consultant or contractor.

Question 10b:

If the answer to questionQuestion 10a is yes, state whether you have reported this violation to your
supervisor, compliance office, whistleblower hotline, ombudsman, or any other available
mechanism at the entity for reporting violations.

Question 10c:

If the answer to questionQuestion 10b is yes, provide details.

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Question 10d:

Provide the date on which you took the actionsaction(s) described in questions 10aQuestions 10b
and 10b10c.

Question 11a:

Indicate whether you have taken any other action regarding your complaint, including whether you
complained to the CommissionCFTC, another regulator, a law enforcement agency, or any other
agency or organization;, or initiated legal action, mediation or, arbitration, or initiated any other
action.

Question 11b:

If you answered yes to questionQuestion 11a, provide details, including the date on which you
took the action(s) described, the name of the person or entity to whom you directed any report or
complaint, and contact information for the person or entity, if known, and the complete case name,
case number, and forum of any legal action you have taken.

Question 12:

Provide any additional information you think may be relevant.

Section E: Whistleblower Eligibility Requirements Andand Other Information
Question 1:

State whether you are currently, or were at the time that you acquired the original information that
you are submitting to the CommissionCFTC, a member, officer or employee of the Department of
Justice, the Commodity Futures Trading Commission, the Comptroller of the Currency,: the
CFTC; the Board of Governors of the Federal Reserve System,; the Office of the Comptroller of
the Currency; the Board of Directors of the Federal Deposit Insurance Corporation,; the Director
of the Office of Thrift Supervision,; the National Credit Union Administration, Board; the
Securities and Exchange Commission,; the Department of Justice; a registered entity,; a registered
futures association,; a self-regulatory organization,; a law enforcement organization; or anya
foreign regulatory authority or law enforcement organization.

Question 2:

State whether you are providing the information pursuant to a cooperation agreement with the
CommissionCFTC or with another agency or organization.

Question 3:

State whether you are providing this information before you (or anyone representing you) received
any request, inquiry or demand that relates to the subject matter of this submission (i) from the
CommissionCFTC, (ii) in connection with an investigation, inspection or examination by any
registered entity, registered futures association or self-regulatory organization, or (iii) in
connection with an investigation by the Congress, or any other federal or state authority.

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Question 4:

State whether you are currently a subject or target of a criminal investigation, or whether you have
been convicted of a criminal violation, in connection with the information you are submitting to
the CommissionCFTC.

Question 5:

State whether you are currently, or were at the time that you acquired the original information that
you are submitting to the Commission, a member, officer or employee of a foreign regulatory
authority or law enforcement organization.

Question 6:

State whether you acquired the information you are providing to the CommissionCFTC from any
individual described in Questions 1 through 54 of this Sectionsection.

Question 7:

Use this space6: If you answered yes to any of Questions 1 through 5, please provide additional
details relating to your responses to questions 1 through 6 of this Section.

SECTION F: Whistleblower’s Declaration.
You must sign this Declaration if you are submitting this information pursuant to the Commodity Futures
Trading CommissionCFTC whistleblower program and wish to be considered for an award. If you are submitting
your information using the electronic version of Form TCR through the Commission’sCFTC’s web portal, you must
check the box to agree with the declaration. If you are submitting your information anonymously, you must still
sign this Declaration (using the term “anonymous”) or check the box as appropriate, and, if you are represented by
an attorney, you must provide your attorney with the original of this signed form, or maintain a copy for your own
records. If you are not submitting your information pursuant to the Commodity Futures Trading CommissionCFTC
whistleblower program, you do not need to sign this Declaration or check the box.
SECTION G: Counsel Certification
If you are submitting this information pursuant to the Commodity Futures Trading CommissionCFTC
whistleblower program and you are doing so anonymously through an attorney, your attorney must sign the Counsel

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Certification sectionSection. If your attorney is submitting your information using the electronic version of Form
TCR through the Commission’sCFTC’s web portal, he/she must check the box to agree with the certification. If you
are represented in this matter but you are not submitting your information pursuant to the Commodity Futures
Trading CommissionCFTC whistleblower program, your attorney does not need to sign this Certification or check
the box.
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