// intake

Crypto Scam Incident & Recovery Intake Form

Provide the information you have available so the case can be assessed. Official channels only — never send money, and never share seed phrases or private keys.

Please provide the information you have available. Do not submit passwords, seed phrases, private keys or authentication codes. Never send money to anyone claiming to represent this investigation.

1. Client details

Full name *

Email address *

WhatsApp / phone number

Country

2. Scam summary

When did the scam occur?

Approximate amount lost & currency/crypto

How were you approached?

X, Telegram, WhatsApp, website, exchange, etc.

Briefly explain what happened *

From the first contact to the loss.

3. Scammer / platform details

Scammer's name, alias or company/platform name

Social-media username(s), phone number(s), email(s) or website/domain

Wallet address(es) provided by the scammer

Any other identifying information you have

4. Transaction details

Blockchain used

e.g. Bitcoin, Ethereum, Solana, Tron, BNB Chain

Transaction hash / transaction signature(s)

Wallet address you sent funds from

Date(s) and approximate time(s) of transfer

5. Evidence & actions already taken

Evidence available

Screenshots, chats, receipts, emails, links, etc.

Have you reported the incident to an exchange, bank, police or cybercrime authority?

If yes, provide details.

Are you still in contact with the scammer or receiving recovery offers?

6. Client declaration

I confirm that the information provided is accurate to the best of my knowledge.
I understand that submitting this form does not guarantee recovery of funds.
I authorize the agency to review the information and blockchain transaction details I provide for the purpose of assessing and investigating my case.

I agree to the declaration above.

Client signature *

Type your full name as signature.

Date *

Security warning

Never send money to anyone claiming to assist with recovery. Never provide your seed phrase, private key, wallet password, exchange password, PIN, 2FA code or recovery code. A legitimate investigator should not require these.