Consumer_Complaint

GOVERNMENT OF THE DISTRICT OF COLUMBIA

Department of Insurance, Securities and Banking

Consumer Complaint Form

The Role of the Department of Insurance, Securities and Banking (DISB)

As part of our responsibility, DISB investigates complaints against the financial entities that we regulate (see list of financial entities below). The Commissioner is empowered to bring administrative action if there are violations of the laws or regulations that DISB administers. In appropriate cases, DISB will refer matters to the proper authorities for investigation and/or criminal prosecution.

Please understand that as an administrative agency our authority is limited. DISB will thoroughly investigate your complaint and make every effort to bring about a satisfactory resolution. If the circumstances of your complaint require legal action, you may wish to consult an attorney.

List of Non−Bank License Categories

LICENSE CATEGORY ACTIVITIES REGULATED

Mortgage Lenders and Brokers

Persons and companies which do mortgage lending/brokering on residential properties (single to 4−family home to be occupied by the borrower) located in the District.

Check Cashers

Persons and companies doing check cashing and deferred deposit activities in the District.

Money Transmitters

Persons and companies selling or issuing payment instruments (e.g. money orders) or engaging in the business of receiving money for transmission or transmitting money within the U.S. or to any location abroad by any and all means, including but not limited to payment instrument, wire, facsimile, or electronic transfer.

Money Lenders

Persons and companies making unsecured loans under $25,000 in the District of Columbia.

Consumer Sales Finance Companies

Persons and companies selling consumer goods through retail credit installment contracts; and

Persons and companies selling automobiles through retail credit installment contracts.

Consumer Credit Service Organizations

Consumer credit service organizations operating in the District of Columbia.

List of Chartered and/or Regulated Financial Institutions

CATEGORY

ACTIVITIES CHARTERED AND/OR REGULATED

Banks

District of Columbia chartered banks (DISB shares regulatory oversight with the FDIC for state chartered banks that are not members of the Federal Reserve System).

Joint Accounts

Joint accounts held in banks, trust companies, savings banks, building associations, or other banking institutions.

Common Trust Funds

Common trust funds held by banks or trust companies qualified to act as fiduciary in the District of Columbia.

Trust Companies

Corporations engaged in trust business in the District of Columbia.

Building Associations

Incorporated building or homestead associations operating in the District of Columbia.

Regional Interstate Banking

Out−of−state regional bank purchases and/or acquisitions of District banks. (District Community Reinvestment Act requirements are listed here).

Questions or Concerns Regarding Financial Entities Not Located in the District

QUESTIONS OR CONCERNS REGARDING:

PLEASE CONTACT

Credit Reporting Agencies, creditors and others financial entities not listed below

Federal Trade Commission

Consumer Response Center

600 Pennsylvania Avenue, NW, Rm. 130

Washington, DC 20580

(202) 326−3128

National banks, federal branches/agencies of foreign banks (word “National” or initials “N.A.” appear in or after bank’s name)

Office of the Comptroller of the Currency

Customer Assistance Group

1301 McKinney Street, Suite 3710

Houston, TX 77010

(800) 613−6743

Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks)

Federal Reserve Board

Division of Consumer & Community Affairs

Washington, DC 20551

(202) 452−3693

Savings associations and federally chartered savings banks (word “Federal” or initials “F.S.B.” appear in federal institution’s name)

Office of Thrift Supervision

Consumer Affairs Division

1700 G Street, NW

Washington, DC 20552

(800) 842−6929

Federal credit unions (words “Federal Credit Union” appear in institution’s name)

National Credit Union Administration

1775 Duke Street

Alexandria, VA 22314

(703) 518−6330

Banks that are state−chartered, or not Federal Reserve System members

Federal Deposit Insurance Corporation

Division of Compliance & Consumer Affairs

Washington, DC 20429

(800) 934−FDIC

Guidelines for Completing this Form

• Please take the time to read these guidelines because they will help you to better understand our functions and

• Please complete as much as possible the consumer complaint form.

• Please submit the consumer complaint form upon completion.

• Please retain a printable version for your files.

allow us to better serve you.

SECTION I – CONSUMER INFORMATION

Your Name: (Last, First, MI)

Your daytime phone:

Your Street Address:

City:

State:

Zip code:

SECTION II – FINANCIAL ENTITY INFORMATION

Name of Financial Entity:

Street Address:

City:

State:

Zip code:

Type of account in question:

Checking

Savings

Mortage

Loan Account

Other (explain)

Other:

Account # :

SECTION III – NATURE OF THE PROBLEM

Briefly describe the nature of your complaint and the events in the order in which they happened, including specific dates and the financial entity’s actions to which you objected. Enclose COPIES of any pertinent information or correspondence that may be helpful. PLEASE DO NOT SEND ORIGINALS OR YOUR ONLY COPY OF ANY DOCUMENT . Keep a copy of this response for your own files. (If additional space is needed, please attach a separate sheet)

Have you attempted to resolve your complaint directly with the financial entity?

YES

Please contact the financial entity and attempt to resolve your complaint BEFORE sending this form.

Name of person(s) contacted:

Date(s) contacted:

Financial entity’s response: (If additional space is needed, please attach a separate sheet)

SECTION IV –RESOLUTION

Please type below your proposed resolution:

PRIVACY STATEMENT

The information requested on this form will be used to investigate and respond to your complaint. In our efforts to resolve your issue, this information may be disclosed outside of the agency to the financial entity which is the subject of your complaint; to any involved third parties; to the federal agency that has supervisory authority over the subject financial entity; to appropriate federal, state or local law enforcement authorities if a violation or possible violation of civil or criminal law is discovered; or to a legislative office in response to any inquiry made at your request.

DISCLOSURE

I wish to file a complaint against the financial entity named in this complaint form, with the understanding that DISB may conduct an investigation on my behalf. However, I understand that DISB does not have the authority to act as a judge in factual disputes. I understand that completion of this form is voluntary, but failure to provide requested information and/or failure to sign this form may delay or preclude investigation of my complaint. I understand that, as part of DISB’s investigation on my behalf, a copy of this form will be forwarded to the financial entity mentioned in the complaint.

Date:

I have read and agree to the terms above:

Agree and Accept

You must read and accept the disclosure

in order to submit this form online