Fraud Victim Registration Form

A scam operation in Southeast Asia was recently dismantled, and a list of telecommunications fraud victims was recovered. If you have lost money to fraud and are willing to work with us, complete this voluntary registration form. We will use your information to assist with the recovery of your funds.

Please complete the required fields marked with * before submitting.

Before you begin

You will need approximately 5–10 minutes. Have your transaction records available if possible. All fields marked with * are required. Your information is transmitted over an encrypted connection and used solely for the purpose of evaluating your claim.

Form IFV-1 (Rev. 09/2026) · OMB No. 3120-0089 · Est. completion: 8 minutes

Section 1 — Applicant Information

Provide your legal name and contact details as they appear on your identification.

First name *

Enter your first name.

Last name *

Enter your last name.

Age *

Enter a valid age (18–110).

Country of residence *

Select your country of residence.

State / Province / Region

Section 2 — Contact Information

We will use this information to contact you regarding your claim. Provide at least one reliable contact method.

Email address *

Enter a valid email address (e.g., name@example.com).

Phone number *

Enter a valid phone number (e.g., +1 555 123 4567).

Section 3 — Incident Details

Tell us about the fraud you experienced. Answer as accurately as you can.

What type of scam did you experience? *

Select the type of scam you experienced.

How did you pay the scammer? *

Select all that apply.

Bank / wire transfer Cryptocurrency Gift cards Peer-to-peer app (Zelle, Venmo, Cash App) Credit / debit card Cash in person International money order Other

Select at least one payment method.

Approximate amount lost (USD) *

Enter the approximate amount you lost in US dollars.

When did the scam occur? *

Tell us when the scam occurred (month/year is fine).

Do you still have evidence of the fraud? *

Yes No

Select whether you still have evidence.

Which types of evidence do you have?

Bank or card statements Transaction receipts or hashes Screenshots of chats or profiles Emails Phone or call records Contracts or documents Other

Brief description of what happened

Maximum 2,000 characters.

I certify that the information I have provided is true and accurate to the best of my knowledge, and I consent to being contacted by the United States Internet Fraud Registry regarding the recovery of my funds.

You must certify and consent to contact before submitting.

Penalty for false statements: Knowingly providing false information on this form may result in denial of your claim (18 U.S.C. § 1001).