Unnamed Project

SECTION 1: APPLICANT INFORMATION

Full Name *

Date of Birth *

Nationality *

Contact Number *

Email Address *

Gender *

MaleFemale

Full Residential Address *

Date of Fraudulent Activity - From *

To (if applicable)

Approximate Amount Lost (USD) *

$

Brief Description of Incident *

Each verified applicant is qualified for $14,700,000.00 compensation and you're required to choose a method to receive this payment.

Disbursement Method (choose one) *

☐ Bank Transfer☐ ATM card☐ Cash Delivery