— Seeking Victim Information in Qidian, LLC, Records Investigation

Contact Information

First Name

Middle Name

Last Name

Date of Birth

Year / Month / Day

Phone Number (no dashes, spaces, or parentheses)

Email Address

Address Line 1

Address Line 2

City

State

Country

ZIP/Postal Code

Questionaire

1. Have you invested with Bin Hao and/or with his company, Qidian, LLC, in any commercial or residential real estate development projects? If yes, please continue with the questionnaire. If no, please notify us at Qidian-Investigation@fbi.gov that we have the wrong information to avoid receiving any future contact.

Yes
No

2. You may have additional names associated with your investment account that differ from the name provided above, such as a nickname or the name of a spouse also on the account. If this is the case, please list additional names associated with the investment account below:

3. Please list the relevant date ranges for your investment(s) with Bin Hao

4. How did you communicate with Bin Hao?

We Chat

Yes
No

Please list the email addresses used by Hao below:

Phone Calls

Yes
No

Please list the number(s) used by Hao below:

Text Messages

Yes
No

Please list the phone number(s) used below:

Other

Yes
No

Please explain:

5. What was the primary language you used to communicate with Bin Hao?

6. Did you attend any in-person investor pitch meetings prior to investing?

Yes
No

If yes, when, where, and who else attended?

If yes, have you preserved any written communications, pitch materials, or recordings of the meeting? If yes, please provide digital copies of said communications, either written or recorded, to Qidian-Investigation@fbi.gov

Yes
No

7. Please list the specific and material representations made to you by Bin Hao, or anyone else on his behalf, prior to investing that you now believe or know to be false. Please specify who made each of the representations if not Bin Hao and if the representations were made written or orally:

8. As a result of this offense, I have: (Select all that apply)

a. Become insolvent;

b. Filed for bankruptcy under the Bankruptcy Code (title 11, United States Code);

c. Suffered substantial loss of a retirement, education, or other savings or investment fund;

d. Made substantial changes to my employment (such as postponing retirement plans);

e. Made substantial changes to my living arrangements (such as relocating to a less expensive home);

f. Suffered substantial harm to my ability to obtain credit;

g. None of the above.

9. Are you aware of anyone else who may have invested with Bin Hao and have been defrauded by Bin Hao? Please provide names and contact information for anyone you believe may also have been defrauded by Bin Hao.

After submitting this questionnaire response, please email supporting documentation to Qidian-Investigation@fbi.gov. Providing additional documentation is voluntary; however, your responses may be helpful to the ongoing investigation and help determine if you were the victim of a crime. In this email, please include the following attachments in a zip file:

1. This investment spreadsheet, filled out to include all investments associated with Bin Hao and/or his company, Qidian, LLC;
2. Executed legal documents for each investment;
3. Documentation of the source of investment funds, to include copies of checks, wire transfer receipts, bank statements, and/or direct deposit slips for each investment (please specify if this money came from a bank account, a 401K, or other source);
4. Any recorded substantive communications (written or verbal) with Bin Hao and/or associates.

If you do not have access to Microsoft Excel to fill out the investment spreadsheet, have challenges sending electronic copies of the requested files, or have any other questions about the request for supporting documentation, please contact Special Agent Cameron Mizell by email Qidian-Investigation@fbi.gov or by mobile phone (857) 998-3084.

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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Seeking Victim Information in Qidian, LLC, Records Investigation

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