Title (Required)Miss.Mr.Mrs.Ms.Mx.Other

First Name (Required)

Last Name (Required)

Email (Required)

Phone Number (Required)

How much money have you have lost? (Required) Please select the amount range that best represents your losses£0 – £1,999£2,000 – £2,800£2,801 – £9,999£10,000 – £24,999£25,000 – £49,999£50,000 – £99,999£100,000+

Was it the first transaction in the last five years? (Required) YesNo

Did you open an account as part of the scam? (Required) YesNo

What was the name of the bank you used for the transaction? (Required) Please select a suitable category from the following drop downAtom BankBank of Scotland PLCBarclaysBinanceCahootCater AllenLimitedChaseClydesdale BankCoinbaseCo-op BankCrypto.comeToroFirst DirectHalifaxHSBCIntelligent FinanceLloyds BankM&S BankMetro BankMonzoNationwide Building SocietyNatwestPayPalPost Office MoneyRevolutSantanderStarlingTesco BankTSBUlster BankVirgin MoneyWestern UnionWiseYorkshire BankOther

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