ASX Complaint Form
Please complete this form and attach any supporting documentation and send via one of the options below:
Customer Service 
ASX Group
PO Box H224
Australia Square  NSW  1215
Email: info@asx.com.au
Fax: +61 2 9227 0885
If you have queries regarding this form please contact Customer Service on 131 279 or +61 2 9338 0000
	
Please choose the category(s) that the complaint relates to. 	
 Company Complaint	  Broker Complaint   	  Trading Activity Complaint   	
 Warrant Issuer	  ASX Group   	  Clearing & Settlement   	
Section 1: personal dETAILS	
Complainant’s First Name	Complainant’s Last Name	
     	     	
Street Address	
     	
City	State	Postcode	
     	     	     	
Home Phone	Work Phone	
(         )      	(         )      	
Mobile	Holder Identification Number (HIN) (If applicable)	
(         )      	     	
E-mail Address	
     	
Are you lodging this complaint on behalf of another person? (If yes please fill out below otherwise skip to Section 2)		
 Yes	 No	
Relationship to complainant?	
     	
What authority do you have to act on behalf of the complainant?	
     	
First Name	Last Name	
     	     	
Company/ Organisation Name	
     	
Street Address	
     	
City	State	Postcode	
     	     	     	
Home Phone	Work Phone	
(         )      	(         )      	
Mobile	E-mail Address	
(         )      	     	

Section 2: THE COMPLAINT	
The entity your complaint relates to	
     	
Contact Person within the entity (If applicable)	
     	
Street Address	
     	
City	State	Postcode	
     	     	     	
If this complaint relates to Option, Futures or Warrants (“ASX Derivative Product”), please advise the following:	
Have you received and signed a Client Agreement form with respect of the ASX Derivative Product?		 Yes	 No	
Name of Participant through which transaction was placed:			
Did you receive advice before trading or subscribing for the ASX Derivative Product?		 Yes	 No	
If yes, is your adviser an Accredited Derivatives Adviser?	 Yes	 No	
Please provide full and specific details of the complaint including:
•	Relevant dates
•	Identification of the securities involved
•	Instructions given
•	If the complaint related to Options, Futures or Warrants, please answer the questions below	
     	

Section 3	
Have you lodged this complaint anywhere else? If so, please provide the following information otherwise skip to Section 4		 Yes	 No	
Who did you lodge your complaint with?	     	
Who dealt with your complaint?	     	
When was the complaint lodged?	     	
What action was taken in relation to your complaint?	
     

	
Section 4	
Do you give consent to ASX contacting the other party regarding this complaint? (If applicable)		 Yes	 No	

     	

     	
Signature	Date	

Documents
If you have relevant documents please send us a copy. Do not send us the original documents now. Keep original documents in a safe place in case they are needed later	

The information contained herein does not constitute financial product advice. You should obtain independent advice from an Australian financial services licensee before making any investment or financial decisions. Although ASX Limited ABN 98 008 624 691 and its related bodies corporate ("ASX") have made every effort to ensure that the information contained herein is accurate and reliable, ASX does not give any warranty or representation as to the accuracy, reliability or completeness of the information. All ASX information and correspondence is intended for the exclusive use of the addressee, and must not be used or relied upon by others. To the extent permitted by law, ASX and its employees, officers and contractors shall not be liable for any loss or damage arising in any way (including by way of negligence) from or in connection with any information provided or omitted, or from anyone acting or refraining to act in reliance on this information.
© Copyright 2014 ASX Limited ABN 98 008 624 691. All rights reserved 2014. 
PRIVACY NOTIFICATION OF COLLECTION STATEMENT 
This is the Notification of Collection Statement ASX is required to provide you with at the time of obtaining your Personal Information. This forms part of ASX’s Privacy Policy.
This information is collected by ASX to effectively deal with your enquiry or complaint and failure to provide this information to ASX is likely to prevent ASX from being able to assist you with your request. Should you wish to, you can access the information you provide to ASX by contacting ASX Customer Service. ASX may from time to time use external service providers but will not disclose personal information you provide to any other organisations or individuals, unless required or authorised by law to do so or unless you consent to the disclosure. ASX does not generally provide personal information to overseas parties and if you would like to contact us or would like further information about lodging a complaint please refer to the ASX's Privacy Policy/Statement at asx.com.au/about/privacy-statement.htm