DFRF Victim Questionnaire (English)

Seeking Victims in DFRF Investment Fraud Scheme

The FBI is seeking victims who may have been defrauded through an alleged investment fraud scheme operated by Daniel Fernandes Rojo Filho beginning in 2014.

Investor Information

First Name

Middle Name

Last Name

Address Line 1

Address Line 2

City

State

Country

ZIP/Postal Code

Best Contact Number

E-Mail Address

Questions

1. Did you invest with DFRF?

Yes
No

2. How much money did you invest with DFRF?

3. When did you invest with DFRF? Provide approximate date(s)

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4. What method(s) did you use to invest with DFRF? (Check, wire, cash, etc).

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5. What bank(s) did you use to send the funds? (When applicable)

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6. What bank(s) received the funds? (When applicable)

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7. Did you receive any money back from the investment(s)?

Yes
No

7a. If yes, when did you receive the funds and how much did you receive?

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8. Did you attend any DFRF conferences?

Yes
No

8a. If yes, when and where did you attend the conference(s)?

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9. Would you like to provide additional information relevant to this investigation?

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10. Do you have any relevant supporting documents you would like to submit? (e.g., bank/brokerage statements, investment certificates, checks, insurance certificates, etc.)

Yes
No

If yes, please submit any documents that corroborate the above claims to DFRFVictim@ic.fbi.gov

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

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DFRF Victim Questionnaire (English)

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