Which:

Which financial service provider is the complaint about?*

Name:

FDR:

FSPR:

NZ Forestry & Land Investments Limited

FM0814

FSP134824

Prosper Hills (2012) Limited

FM1088

FSP217605

Prosper Hills (2008) Limited

FM0814

FSP134825

Ross Anthony Collins

FM0814

FSP134826

Anthony Shane Collins

FM0814

FSP134844

Shareholder Name:*

Share Codes:*

When:

On what date did the event take place?*

Complaint:

What is your complaint about?*

Attach File:

Attach File:

Your complaint or other supporting documents can be attached to this form.

Who:

Your name:*

Complainant name:
(i.e. if you are making the complaint on behalf of someone else.)

Do you have the authority to act on the complainants behalf?:

Your Details:*

Complainant details: (if different)

Address:*

Phone:

Mobile:

Email:

Fax:

Your preferred method of contact:*

Outcome:

What would you like to happen to resolve the issue?*

Confirmation:

I understand that all information collected and held by Financial Dispute Resolution (FDR) scheme members may be shared with the FDR and engaged solicitors for the scheme member solely for the purposes of my complaint resolution. I understand that this is not the final course of action and acknowledge I have been informed about other courses of action to resolve the dispute. I have been informed that I will incur no costs personally whilst utilising the scheme members Internal Complaints Process OR the FDR Complaints Process.*

* indicates required fields