3235-0748 OMMS Form

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U.S. SECURITIES AND
EXCHANGE COMMISSION

OMB Number: 3235-0748
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Ombudsman Matter Management System (OMMS) Submission Form
Thank you for contacting the Ombudsman for assistance. For more information about the Office of the Ombudsman and how
the Ombudsman may be able to assist you, please visit sec.gov/ombudsman (https://www.sec.gov/ombudsman).

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Important Information

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About You
Are you a Retail (Individual) Investor?* 
Yes

No

May we contact other U.S. Securities and Exchange Commission (SEC) Division(s) or Office(s), Self-Regulatory Organizations
(SROs), individuals, and/or entities regarding this matter?*
Yes

No

Prefix
--None-First Name*

Last Name*

Address

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City

Country
United States
State/Province
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Phone Number** 

Email**

** You must provide either a phone number or an email address.

Your Matter
Is your matter about the U.S. Securities and Exchange Commission (SEC)?*
Yes

No

Is your matter about a Self-Regulatory Organization (SRO)?* 
Yes

No

What is your matter about?* 
Select one...

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Describe your matter in detail.* 

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Additional Matter Details

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Entities And Individuals Involved

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Have You Already:
Contacted the SEC about this matter?*
Yes

No

Contacted any Self-Regulatory Organizations (SROs) directly?*
Yes

No

Contacted any other regulators and/or law enforcement agencies directly?*
Yes

No

Taken any legal action?*
Yes

No

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The information referenced in the OMMS Submission Form is informal and is not binding on the staff or the
Commission.   The information is provided as a service to investors.   It is neither a legal representation nor a
statement of SEC policy.   SEC staff cannot act as your personal representative or attorney.   For specific
information on protecting your particular rights, or if you feel you need a definitive legal analysis of your
particular situation, it may be in your best interest to consult with an attorney who specializes in securities law.
This collection of information has been reviewed by the Office of Management and Budget (OMB) in accordance
with the clearance requirements of 44 U.S.C. §3507.  The applicable Privacy Act System of Records Notice (SORN)
is SEC-31 and the routine uses of the records are set forth at 85 FR 85440 (January 27, 2021).  
Ombudsman | U.S. Securities and Exchange Commission | 100 F Street NE | Washington, DC 20549
202.551.3330 | toll-free 877.SEC.2001 (877.732.2001)  
[email protected] | https://www.sec.gov/ombudsman

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