Seeking Victim Information in Bryant United Capital Funding, Inc. Investigation

If you have been directed to this questionnaire via an FBI victim notification letter, it is because you have been identified as having business dealings with Bryant United Capital Funding, Inc. (BUCF) and may be a victim of fraud. To assist in the investigation and to be provided with information on resources available to victims, please answer the questions below to the best of your ability. It may be that you have already provided this information to the FBI, but please provide it again on this questionnaire. Based on your responses, you may be contacted by the FBI and asked to provide additional information. Please e-mail copies of any records you have related to BUCF to BUCFVictim@ic.fbi.gov. Additionally, please retain all original records, including e-mails, that you may have in your possession, as they may be needed in the future. You are encouraged to share the link to this questionnaire with any other potential victim you may be aware of.

If you have any questions regarding this questionnaire or resources for victims, please e-mail BUCFVictim@ic.fbi.gov.

Contact Information

First Name

Middle Name

Last Name

Victim Business Name (if applicable)

Address Line 1

Address Line 2

City

State

Country

ZIP/Postal Code

Best Contact Number

E-Mail Address

Questions

1. When did you first learn about BUCF? Provide approximate date.

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2. If you were introduced or referred to the BUCF investment opportunity, who provided the referral?

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3. Who was your point of contact at BUCF and where did you meet this person? Provide name, contact information (address, work phone, cell phone, e-mail), etc.

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4. Who at BUCF described the investment opportunity to you? Provide name(s) of individual(s) associated with BUCF who explained the investment, how your funds would be invested, and the nature and amount of any returns on investment.

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5. Were you offered a referral fee for individuals who later invested with BUCF?

Yes
No

5a. If yes, who offered this and how much were you offered? Provide name of person and amount of referral fee.

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6. Were you provided with a written agreement? (i.e., partnership agreement, etc. related to your investment with BUCF)

Yes
No

6a. If yes, who provided this agreement to you? Provide name of person(s) affiliated with BUCF.

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7. How did you deliver your initial investment?

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8. Did you give BUCF authorization to transfer your funds to any other entity/person?

Yes
No

9. How did you receive your monthly statements? (e.g., mail, e-mail, hand delivery, etc.)

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10. How did you receive any disbursements of earnings or interest? (e.g., check, electronic funds transfer, etc.) Answer if applicable.

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11. Describe any disbursements that you deferred/reinvested. If applicable, describe any disbursements of earnings or interest that you deferred and instead elected to reinvest with BUCF; provide approximate dollar amount and approximate date of deferral.

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12. Provide your approximate principal account balance of funds as of April 30, 2017.

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13. When did you learn about the SEC inquiry into BUCF? Provide approximate date you became aware of the U.S. Securities and Exchange Commission’s inquiry into BUCF.

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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 Bryant United Capital Funding, Inc. Investigation

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