Mississippi Secretary of State - Stanford Group Complaint Form

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Stanford International Bank (SIB) CD Investor Form

Please complete the items below to the best of your ability and with as much detail as possible. After you have filled in all of the required information (denoted by * ) and clicked on the button, you will receive an e-mail confirming that your report has been received by the Secretary of State's Office.
Thank You.

	Your Information
Name:	First:* Last:*
Relationship to CD Purchaser or Account Holder
Address:
City:	State: Zip:
Phone 1:	*
Phone 2:
E-mail:	*
Fax:
Name of CD Purchaser / Account holder:
Type of Account in which CD was purchased:
Account Number:
Date and Dollar Amounts Purchased:
Name of Sales Agent who sold you the CD:
	Do you currently have any sales literature or marketing material given to you regarding the CDs?
	No Yes

	Do you currently have any account statements showing the status of your CD investment?
	No Yes

	Do you currently have any correspondence (letters, e-mail, newsletters) from your sales agent or Stafford regarding the CDs?
	No Yes

	Describe in detail the circumstances of how you came to purchase this CD. (How you were approached, what you were told about this product, questions of information asked of you, questions you asked, etc...) (4000 Characters Maximum)