نموذج الشكوى

Name
This field is for validation purposes and should be left unchanged.
Type of Allegation (select all that apply)*
- Audit and attestation services
- Tax services
- Due professional care
- Practicing without a license
- Other
Complainant Information (individual making the complaint)
Individual making the complaint. For anonymous complaints: do not complete this section.
Name
First Last
Email
Phone
Address
Street address Address line 2 City State ZIP code

General Information for the Complaint
Have you contacted the individual or firm in an effort to resolve the complaint?*
- Yes
- No
If yes, list the steps taken to resolve the complaint. If necessary, use additional sheets of paper.
Have you filed a complaint or intend to file a complaint with another agency?*
- Yes
- No
If yes, name the agency.
Are there other individuals that can provide supportive testimony to your complaint?*
- Yes
- No
If yes, provide contact information.
Name, phone number and address for any individuals.
Is a court case currently in progress regarding the complaint?*
- Yes
- No
- Do not know
If yes, provide contact information for the attorney handling the case.
Name, phone number and address.

Allegations of the Complaint
Provide details of your allegation
Names, dates and other specific information relevant to your complaint.
File upload
Accepted file types: jpg, png, pdf, doc, docx, xls, xlsx, ppt, pptx, txt, rtf, Max. file size: 100 MB.

If you would prefer to upload a file with the details of the complaint you may do so here. Please redact or remove all sensitive information.

Supporting Documentation
Indicate the types of supporting documentation provided.
- Contract
- Engagement letter
- Invoice
- Tax return
- Correspondence
- Financial statement
- Report
- Other
File uploads
Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, xls, xlsx, ppt, pptx, txt, rtf, Max. file size: 100 MB.
Attach supporting documentation to validate allegations referenced in the previous section of this complaint. Please redact or remove all sensitive information.

Certification of Complaint
For anonymous complaints: do not complete this section.
Certifications*
- I, the complainant, certify that the information provided above is true and accurate to the best of my knowledge.
- I understand that if the VBOA determines a violation may have occurred, a copy of this complaint form will be sent to the respondent indicated above.
Complainant name
Date
MM slash DD slash YYYY
Signature
Please use your mouse, touchscreen or touchpad to sign the box above.
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