GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS

Collection: Executive Agency Records
Sub-shelf: ltg.gov.vi (Internet Archive recovery)
Kind: Government Report
Pages: 3
Text: Native Text

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Original source: https://web.archive.org/web/20210423061627id_/https://ltg.gov.vi/wp-content/uploads/2019/01/Complaint-Form_Banking.pdf

SHA-256 135b7a4656a146956eb266f0ea4a834dccf229ce0c92713718dacfcae06d4718

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A public record of the Government of the Virgin Islands, published by the agency itself. No copyright is asserted on it and 17 U.S.C. § 105 does not reach territorial government, so it publishes as a territorial public record.

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Archive identifier LF-135b7a4656a1

Document text

GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF BANKING, INSURANCE AND FINANCIAL REGULATION BANKING COMPLAINT FORM COMPLAINANT: Name: _______________________________________________________ Mailing Address: ______________________________________________ Telephone No.: (_____) ____________ (home)/ (_____) ____________ (Work) STATUS OF COMPLAINANT: COMPLAINT AGAINST: ACCOUNT TYPE: BANK CUSTOMER BANK EMPLOYEE BORROWER TRUSTEE OTHER _____________________________________ BRANCH MANAGER  BANK LOAN CLERK CONSULTANT OTHER___________________________________ Indicate Individual’s/Company’s Name: _____________________________ Telephone No.: (_____) ____________ Facsimile No.: (_____) __________ SAVINGS PERSONAL LOAN COMERCIAL LOAN CHECKING AUTO LOAN MORTGAGE OTHER________________________________________________ Complaint No. ______________ Date Received: ______________ Date Resolved: ______________ 5049 Kongens Gade, Charlotte Amalie, St. Thomas, VI 00802• Tel: (340) 774-7166• Fax: (340)774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Tel: (340) 773-6459 • Fax: (340)719-3801 REASON FOR COMPLAINT: SUMMARY/REASON FOR COMPLAINT: __________________________________ _____________________ Signature Date EXAMINER’S FINDINGS: ____________________________________ ______________________ Signature Date INTEREST RATES MISREPRESENTATION UNEARNED INTEREST SERVICE CLOSING OF ACCOUNTS LOAN BALANCE CANCELLATION WITHOUT WRITTEN NOTICIFICATION DENIAL OF LOAN OTHER ______________________________ 5049 Kongens Gade, Charlotte Amalie, St. Thomas, VI 00802• Tel: (340) 774-7166• Fax: (340)774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Tel: (340) 773-6459 • Fax: (340)719-3801 Hearing Requested By: _______________________ Hearing Date: ____________ Notice of Penalty: ____________________ Penalty Imposed: __________________ Court Action: _______________________ Date: __________________________