Crypto Fraud Information

Fraud/Scam Information:

Full Name

Email Address

Phone Number

Age

Address

Transaction Information:

Date Fraud Began

MM slash DD slash YYYY

Total Amount of U.S. Dollars Invested

Total Amount Victim Believes is In Their Crypto Account

Website

Social Media Platform Address

Encrypted Messaging Platform

Bad Actor Information:

Name

Phone Number

Email Address

Has this incident been reported to any authorities?

Yes

No

If Yes, Which agencies?

Victim Information:

Wallet Address(es) you sent crypto from (your own wallet)

Wallet Address(es) you sent crypto to (scammer's wallet)

Victim Statement:

In your own words, describe everything you can remember about how the scam/fraud occurred.

Document Upload:

Please upload any supporting documents (e.g., screenshots, emails, bank statements)

Max. file size: 124 MB.

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