Please enter the date when you first recognized the occurrence of the reported Incident.
MM
/
DD
/
YYYY
Token Type *
Please specify the tokens and respective blockchains involved. e.g. Bitcoin, Ethereum, USDT-BSC, etc...
Your answer
What kind of digital asset wallet are you using?
Please enter the name of the digital asset wallet you are using.
Your answer
Amount of tokens lost (by type of digital token) *
e.g. XX BTC, XX ETH
Your answer
Value of Lost Tokens (in US Dollars) *
Please enter the value of assets (in USD) that were lost as a result of this incident.
Your answer
Transaction Hash(es) *
Please specify the origin transaction hashes where assets were first stolen or compromised.
Your answer
Victim's Digital Asset Address *
Please provide the digital asset wallet address(es) for where assets were stolen/compromised.
Your answer
Receiver Digital Asset Address *
Please provide the suspicious wallet address(es) for where the compromised funds were first transferred.
Your answer
Website Information (URL)
Please enter URL information for any websites, messengers, and social media sites involved in the incident. (e.g. phishing site involved in digital asset scam.)
Your answer
Nature of Reported Incident *
Please select the field(s) that best describe the Digital Asset fraud/incident you are reporting.
Civil and criminal litigation in progress. *
If you're in the progress of a civil or criminal suit, please enter this part.
Details *
Please describe the case in as much detail as possible. (e.g. Circumstances leading up to the loss of assets or any other information that you think would be useful for our investigations.)
Your answer
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