Submit an Online Financial Exploitation Intake

The Department of Financial Institutions (DFI) regulates state-chartered banks, state-chartered credit unions, securities offerings, securities individuals and entities, money transmitters, check cashers/payday lenders, mortgage lenders and loan officers, and some other consumer/industrial lenders. To file a Financial Exploitation Intake against an entity or offering regulated by DFI, submit this online Financial Exploitation Intake form. Please note, pursuant to Kentucky’s open records laws, any information you provide may by subject to public disclosure upon termination of a formal investigation and immediately if no formal investigation is initiated.

In submitting this complaint, you agree the information provided is true and correct to the best of your knowledge and that the information may be used by the Department for its investigation. Consumer complaints are considered to have been received by the Department in confidence. However, the Department may, at its sole discretion, disclose your complaint and the information you provide to any person or entity it deems necessary for investigative purposes, corrective action, and/or to initiate legal proceedings against appropriate parties.

Please enter the following information for the Reporting Institution:

Name: (required)
Address:
PO Box / Apt#:
City:
State\Country:	Select a State\Country Alabama Arkansas Alberta Alaska Arkansas Australia Arizona British Columbia California Cayman Islands Colorado Connecticut District of Columbia Delaware England Florida Georgia GUAM Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska Newfoundland New Hampshire New Jersey Netherlands New Mexico Nova Scotia Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Philippines Puerto Rico Quebec Rhode Island South Carolina South Dakota Saskatchewan Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming International
Postal Code:
Email Address:
Phone Number:
Institution Case Number:

Please enter the following information for the Contact Person at the Reporting Institution:

First Name: (required)
Last Name: (required)
Address:
PO Box / Apt#:
City:
State\Country:	Select a State\Country Alabama Arkansas Alberta Alaska Arkansas Australia Arizona British Columbia California Cayman Islands Colorado Connecticut District of Columbia Delaware England Florida Georgia GUAM Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska Newfoundland New Hampshire New Jersey Netherlands New Mexico Nova Scotia Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Philippines Puerto Rico Quebec Rhode Island South Carolina South Dakota Saskatchewan Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming International
Postal Code:
Email Address:
Phone Number:

Please enter the following information for the Customer or Client who is the potential victim of the conduct being reported:

Is the Customer or Client a Business or a Person?

Person    Business

First Name:
Last Name:
DOB

Name:

Address:
PO Box / Apt#:
City:
State\Country:	Select a State\Country Alabama Arkansas Alberta Alaska Arkansas Australia Arizona British Columbia California Cayman Islands Colorado Connecticut District of Columbia Delaware England Florida Georgia GUAM Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska Newfoundland New Hampshire New Jersey Netherlands New Mexico Nova Scotia Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Philippines Puerto Rico Quebec Rhode Island South Carolina South Dakota Saskatchewan Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming International
Postal Code:
Email:
Phone Number:

Please enter the Name of the party potentially responsible for the exploitative or violative conduct being reported:

Is the Respondent or Client a Business, Person or Unknown?

Person    Business    Unknown

First Name:
Last Name:

Name:

Address:
PO Box / Apt#:
City:
State\Country:	Select a State\Country Alabama Arkansas Alberta Alaska Arkansas Australia Arizona British Columbia California Cayman Islands Colorado Connecticut District of Columbia Delaware England Florida Georgia GUAM Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska Newfoundland New Hampshire New Jersey Netherlands New Mexico Nova Scotia Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Philippines Puerto Rico Quebec Rhode Island South Carolina South Dakota Saskatchewan Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming International
Postal Code:
Email Address:
Phone Number:

Date complaint event occurred
Complaint Summary: (Max 1,500 Characters) (Required)
Has the reporting institution submitted the complaint to the Kentucky Cabinet for Health and Family Services?	Yes No

I certify that (1) the information provided on or with this form is true and correct to the best of my knowledge and belief, (2) I have read and understand the notice in the paragraph below and (3) I authorize DFI to send a copy of this complaint form to the entity or individual that is the subject of the complaint or to use the information provided in any manner deemed necessary or proper by DFI.

NOTICE: The Department of Financial Institutions does not provide personal legal advice, nor will it represent you in court proceedings. DFI cannot decide disputes, arbitrate claims or order firms or individual to pay judgments in personal disputes. In order to recover lost funds or obtain comparable relief, you should initiate private legal action; prompt action on your part is critical because state and federal laws known as “statutes of limitations” impose strict time limits on filing lawsuits. Thus, you may wish to contact an attorney immediately. For names of attorneys in your area, contact your local bar association.

Your request has been submitted to The Department of Financial Institutions. A confirmation email has been sent to you which will include this case number: