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Platforms Claims Intake Form
We're sorry to hear you've been a victim of an incident requiring you to fill out this form, but we're here to help. Please fill out the information below and we'll begin processing your claim as soon as possible. In the meantime, please take all measures to protect yourself from any further losses.
If you have any questions, please email
[email protected]
Which Custodian/Wallet/Platform were you usin
g?
*
Please enter your full legal name
*
Please enter an email
*
Please provide a phone number
*
Please provide your public key
*
Reporting Date
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Date of incident (the day assets were stolen)
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Approximate value lost (how much crypto was lost?)
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List the specific assets and the corresponding amount lost (Example: .4 BTC, .5 ETH, etc.)
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Description of event (what do you think happened?)
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Upload evidence related to your claim here or you can email them to
[email protected]
. Typical evidence will include police report(s), transaction history, custodian correspondence, etc.
*
Click to choose a file or drag here
Submit
