Kindly provide the information requested below to enable us create an account for you.
Personal Details
First Name
Middle name
Last Name
Address
Country
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State
Select State
City
Zip code
Date of Birth
House Address
Phone Number
Email address
Funds Recovery Details
Type of Scam
Select Type of Scam
Scam Type
Cryptocurrency
Forex
Romance
Marketplace
Taxation
Trading
Celebrity impersonating scam
Inheritance scam
Cash delivery scam
Others
Amount Defrauded
Select Amount Defrauded
$100.00 - $500.00
$700.00 - $1,000.00
$1,000.00 - $2,000.00
$2,000.00 - $5,000.00
$5,000.00 - $10,000.00
$15,000.00 - $20,000.00
$25,000.00 - $30,000.00
$30,000.00 - $70,000.00
$80,000.00 - $140,000.00
$150,000.00 - $300,000.00
$300,000.00 - $300,000,000.00
Brief Us About Your Case
Characters remaining: 2000
Banking Details
Account Type
Please select Account Type
Recovery Account
Crypto Account
Business Account
Account Currency
America (United States) Dollars – USD
Password
Confirm Password
Passport Photograph
