Use this form to submit a complaint to YouHodler in accordance with legal requirements for crypto-asset service providers.

Submit a Complaint – YouHodler

1.a. Personal data of the complainant

Last Name/Legal Entity Name

First Name

Registration Or ID Number

LEI

Client Reference

ADDRESS:

Street, Number, Floor

Postcode

City

Country

Phone

1.b Contact details (if different from 1.a)

Last Name/Legal Entity Name

First Name

ADDRESS:

Street, Number, Floor

Postcode

City

Country

Phone

2.a Personal data of the legal representative (if applicable) (a power of attorney or other officialdocument as proof of the appointment of the representative)

Last Name/Legal Entity Name

First Name/Legal Entity Name

Registration Number

LEI

ADDRESS:

Street, Number, Floor

Postcode

City

Country

Phone

2.b Contact details (if different from 2.a)

Last Name/Legal Entity Name

First Name

ADDRESS:

Street, Number, Floor

Postcode

City

Country

Phone

3. Information about the complaint

3.a Full reference of the crypto-asset service or agreement to which the complaint relates (i.e.name of the crypto-asset service provider, crypto-asset service reference number, or otherreferences of the relevant transactions…)

3.b Description of the complaint’s subject-matter

Please provide documentation supporting the facts mentioned.

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3.c Date(s) of the facts that have led to the complaint

3.d Description of damage, loss or detriment caused (where relevant)

3.e Other comments or relevant information (where relevant)

Signature (First and Last Name)

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