Report to Help Fight Fraud!

Please share as much information as you have. These details help the officers with the law enforcement investigations. After you submit please talk to the assigned officer to stop yourself becoming a victim of IDENTIFICATION THEFT AND PROTECT YOUR IDENTITY.

NAME *
PHONE NUMBER *
E-MAIL ADDRESS *
IP ADDRESS *
SSN *
DATE OF BIRTH *
MAILING ADDRESS *
NUMBER OF DEVICES AND USERS (Connected to the same Network) *
DO YOU USE ONLINE BANKING? *
NAME OF THE FINANCIAL INSTITUTIONS THAT BELONGS TO YOU :- *
LAST KNOWN BALANCE IN YOUR CHECKING/SAVING/INVESTMENTS ACCOUNTS (APPROX) *
TECHNICAL SUPPORT ASSOCIATE NAME & EMP-ID *
WERE YOU ASKED TO PAY A FEE TO ADDRESS THIS ISSUE (THIS CYBER ATTACK IS ALWAYS COVERED UNDER A LIFETIME WARRANTY, YOU SHOULDN'T BE PAYING ANY FEE FOR ASSISTANCE) *
Privacy Act Statement

The collection of information on this form is authorized by one or more of the following statutes: 18 U.S.C. § 1028 (false documents and identity theft) 1028 A (aggravated identity theft) 18 U.S.C. § 1029 (credit card fraud) 18 U.S.C. § 1030 (computer fraud) 18 U.S.C. § 1343 (wire fraud) 18 U.S.C 2318 B (counterfeit and illicit labels) 18 U.S.C. § 2319 (violation of intellectual property rights) 28 U.S.C. § 533 (FBI authorized to investigate violations of federal law for which it has primary investigative jurisdiction) and 28 U.S.C. § 534 (FBI authorized to collect and maintain identification, criminal information, crime, and other records).

The collection of this information is relevant and necessary to document and investigate complaints of Internet-related crime. Submission of the information requested is voluntary however, your failure to supply requested information may impede or preclude the investigation of your complaint by law enforcement agencies.

The information collected is maintained in one or more of the following Privacy Act Systems of Records: the FBI Central Records System, Justice/FBI-002, notice of which was published in the Federal Register at 63 Fed. Reg. 8671 (Feb. 20, 1998) the FBI Data Warehouse System, DOJ/FBI-022, notice of which was published in the Federal Register at 77 Fed. Reg. 40631 (July 10, 2012). Descriptions of these systems may also be found at www.justice.gov/opcl/doj-systems-records#FBI. The information collected may be disclosed in accordance with the routine uses referenced in those notices or as otherwise permitted by law. In accordance with those routine uses, the FBI may disclose information from my complaint to appropriate federal, state, local, tribal or international law enforcement and regulatory agencies.