// intake

Crypto Scam Incident & Recovery Intake Form

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

Provide the information you have available. Leave a field blank if it does not apply or you do not know the answer. We will never ask you to send money, submit passwords, share your seed phrases, private keys or access to your wallet during the recovery process.

1. Client details

Full name *

Email address *

Country *

Required — used to set your phone country code.

WhatsApp / phone number *

Enter the national number only — country code is applied automatically.

Stored as +……

2. Scam summary

When did the scam occur?

Leave blank if unknown.

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

Pick each transfer date. Optionally add an approximate time. Add another row for multiple transfers.

Transfer 1

Date

Add time

5. Evidence & actions already taken

Evidence available

Drop screenshots, chats, receipts, or short clips — or click to browse. Up to 12 files, 12.0 MB each. Images and PDFs preview as you attach them.

Drag & drop

PNG, JPG, WEBP, GIF, PDF, MP4, WEBM — multiple files welcome

Browse files

Notes / links

Optional — paste URLs or anything that does not fit as a file.

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.