Report a Fraud - Ademi & Fruchter LLP

If you would like to report a suspected fraud, abuse, or violation to us, please enter the details below and we will look into your concerns as soon as possible. Submitting this form does not create an attorney-client relationship, and as such you should refrain from submitting confidential information until you are in direct contact with an attorney.

Name

First Name *

Middle Initial

Last Name *

Institution Name (if applicable)

Position In Institution (if applicable)

Address

Address More

City

State

ZIP / Postal Code

Phone *

Email *

Additional Questions (Fraud)

Check this box if you would like to complete this electronic certificate and act as a plaintiff and/or lead plaintiff by answering a few additional questions (questions will appear below). Ademi & Fruchter, LLP will prosecute this action on a contingent fee basis and will advance all costs and expenses. You may uncheck this box at any time if you change your mind before submitting this form.

Additional (Fraud)

Employee *

Certification

I, the Plaintiff, certify that:
1. I have reviewed the Complaint and authorized its filing.
2. Plantiff did not purchase the security that is the subject of this action, at the direction of plaintiff’s counsel or in order to participate in any private action arising under this title.
3. I am willing to serve as a representative party on behalf of a class and will testify at deposition and trial, if necessary.
4. My transactions in the securities, which are the subject of this action, during the Class Period set forth in the Complaint are as follows:

5. I have not served as a representative party on behalf of a class under the federal security laws during the last three years, except if detailed below.

#5 text

6. I will not accept any payment for serving as a representative party, except to receive my pro rata share of any recovery or as ordered or approved by the court including the award to a representative plaintiff of reasonable costs and expenses (including lost wages) directly relating to the representation of the class.

True & Correct *

I declare under penalty of perjury that the foregoing are true and correct statements.

Authorized *

By clicking on the button below, I certify that I am authorized to sign this form, and I authorize and, upon execution of the accompanying retainer agreement by Ademi & Fruchter, LLP, retain Ademi & Fruchter, LLP to file an action under the federal securities laws to recover damages and to seek other relief against defendant. Ademi & Fruchter, LLP will prosecute the action on a contingent fee basis and will advance all costs and expenses. The Retention Agreement provided to me is incorporated by reference, upon execution by Ademi & Fruchter, LLP.

Signature

Date of Signing

First Name *

Last Name *

Email *

Company

Phone

Please describe the details of the alleged fraud *

1	Share Info # of Shares Buy Date Price per Share
1	Share Info # of Shares Buy Date Price per Share

1	Share Info # of Shares Sell Date Price per Share
1	Share Info # of Shares Sell Date Price per Share