Seeking Victim Information in Waterford Management Case

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 Waterford Management 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 Waterford Management—such as credit applications, references, bank references, purchase orders, bills of lading, e-mails, etc.—to WaterfordMgmtVictim@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 WaterfordMgmtVictim@ic.fbi.gov.

Contact Information

Authorized Business Representative
The individual listed will be the point of contact for the duration of the investigation

First Name

Middle Name

Last Name

Best Contact Number

E-Mail Address

Victim Business

Business Name

Address Line 1

Address Line 2

City

State

Country

ZIP/Postal Code

Questions

1. When did Waterford Management originally contact you?

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2. What was the name of the person who originally contacted you?

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3. How did you communicate? Select all that apply.

Telephone

E-Mail

4. List everyone you spoke with or had e-mail correspondence with at Waterford Management. Provide name(s) and job title(s) if possible.

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5. Did you perform due diligence checks based on the materials provided to you by Waterford Management?

Yes
No

6. Is your merchandise identifiable by any of the following? Select all that apply.

Serial Number

Bar code

Other

6a. If other, provide specific product identifier not listed above.

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7. Is there anything else you would like to comment on concerning your business dealings with Waterford Management? Please provide details.

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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 Waterford Management Case

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