— Seeking Victim Information in Advanced Fee Scheme Investigation

Contact Information

First Name

Middle Name

Last Name

Date of Birth

Year / Month / Day

Phone Number No dashes, parenthesis, or spaces

Email Address

Address Line 1

Address Line 2

City

State

Country

ZIP/Postal Code

1. Please describe your interaction with the scammers. Why did they contact you?

2. How often did you communicate with them?

3. What names did the scammers provide? (Individuals, organizations, etc.)

4. Did the scammers have a website?

Yes
No

5. If so, what was the website URL?

6. How did you communicate with the scammers? (Check all that apply. Multiple allowed)

Phone calls

Emails

Text messages

Other (please explain)

6other

7. What communications accounts did the scammers use? (Check all that apply. Multiple allowed)

Phone

Other (please explain)

7other

8. Why did they send you a check?

9. How did they send the check to you? (Check all that apply. Multiple allowed

USPS

FedEx, UPS or another private carrier

Other (please explain)

9other

10. Regarding the sender of the check, please provide any of the following information you have it:

Name

b. Address

c. Phone

d. Email

11. Did you send the scammers any money? If yes, provide the amount. If no, why not?

12. Were you asked to send money? If yes, how much did you send?

13other

14. If applicable, what was the account number they provided for you to send them money?

15. If applicable, were any of the funds you sent the scammer recovered?

16. Have you received any similar solicitations from other individuals or organizations? If so, what are their names?

17. Is there anything else you believe is pertinent to this investigation?

Captcha

Privacy Act Statement

The FBI is authorized to collect the information on this form by one or more of the following provisions: Title 28, United States Code, sections 533 and 534; Title 28, Code of Federal Regulations, section 0.85; and the Attorney General Guidelines for Victim and Witness Assistance. The information requested will assist the FBI in providing you with assistance to which crime victims are entitled under federal law. You do not have to provide the requested information; however, failure to do so may hinder the FBI in providing you with crime victim assistance. The information collected on this form is protected by the Privacy Act of 1974, as amended, Title 5, United States Code section 552a, and is maintained in the FBI’s Central Records System, DOJ/FBI-002, a description of which was published in the Federal Register at 63 Fed. Reg. 8671 (Feb. 20, 1998) and which may be viewed at www.justice.gov/opcl/doj-systems-records#doj

Official websites use .gov

Secure .gov websites use HTTPS

Seeking Victim Information in Advanced Fee Scheme Investigation

fbi

federal bureau of investigation

FBI.gov Contact Center

Email updates