Disgorgement Claim · Custom Portal

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Applicant Information

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Claim Number

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I have a legal representative

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Claim Questions

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Claim Amount

1. How much money did you invest and how much did you lose in the investment that is subject to the CIRO disgorgement order? Do not include any loss of opportunity to use the money for something else or include interest on your loss. Please provide details.

2. Have you received anything back from your investment? E.g., any benefits, interest, dividends, redemptions, distributions, commissions, or any other payments?

If yes, how much have you received?

Please provide details.

3. Have you received or are you entitled to receive any compensation for your loss from anyone else?

Please provide details.

4. Did you do anything to offset or reduce your loss?

Please provide details.

5. Did you, directly or indirectly, take part in the misconduct that resulted in the CIRO disgorgement order?

Please provide details.

6. Have you ever provided CIRO with records that relate to your loss?

Please provide details.

7. Has CIRO ever denied any of your claims as part of the disgorgement process, for this case or any other case?

Please provide details.

Certification

Upload Attachments (file formats accepted: word, pdf, image, excel, csv, PowerPoint, each file max. size 10MB, max. 5 files allowed) *Supporting documentation is required in order to process your claim.

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