DFI Form 801 (Rev. 05/03)
Consumer Complaint Form
Form 801 (11/03)
STOP: Have you determined that your complaint is against a licensee regulated by the Department of Financial Institutions?
Yes □ No □ (If no, refer to the Department Licensee List on our website http://www.dfi.ca.gov/directory/ to verify the institution
is regulated by the Department of Financial Institution before proceeding.)
Please note: The Consumer Information Desk is unable to assist consumers with complaints against national banks, federal
savings and loan associations or federal savings banks, federal credit unions, or mortgage banker/mortgage brokers.
“Information on Who Regulates Your Financial Institution” is available on our website at
The Department of Financial Institutions is neither an advocate of the individual consumer nor of the licensee. The
Department’s role as part of this complaint process is to facilitate communication between the consumer and their financial
institution. The Department facilitates this communication so that the consumer’s concerns are heard by the appropriate
official within their financial institution. The Department does not guarantee that that this process will result in the outcome
for which the consumer seeks. Those complaints that reach an impasse may require the consumer to obtain their own
private legal counsel.
Once your complaint is received, a copy of the complaint will be forwarded to the Consumer Complaints Administrator of
your financial institution. The department asks that the financial institution respond to you within 20 working days (4 weeks)
from the date your correspondence is forwarded to the financial institution. The institution is requested to respond to both
you and the Department of Financial Institutions.
By submitting this form you agree that you have read the Notice of Individuals which accompanies this form and
can be found at our webpage at http://www.dfi.ca.gov/forms/