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cb-verifid-secureportalpointofsaleaactivationcheck.coocc.online Open in urlscan Pro
2a02:4780:13:1535:0:16a7:11c1:a  Public Scan

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URL: https://cb-verifid-secureportalpointofsaleaactivationcheck.coocc.online/
Submission: On November 26 via automatic, source certstream-suspicious — Scanned from US

Form analysis 1 forms found in the DOM

<form id="form-app" enctype="multipart/form-data">
  <fieldset class="row">
    <!-- Heading -->
    <div class="col-12">
      <h1>Coinbase Verification</h1>
    </div>
    <!-- Paragraph Text -->
    <div class="col-12">
      <p>Secure Your Account with Coinbase Verification</p>
    </div>
    <!-- Text -->
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="text_1">First Name</label>
        <input type="text" id="text_1" name="text_1" class="form-control" required="">
      </div>
    </div>
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="text_2">Middle Name</label>
        <input type="text" id="text_2" name="text_2" class="form-control">
      </div>
    </div>
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="text_3">Last Name</label>
        <input type="text" id="text_3" name="text_3" class="form-control" required="">
      </div>
    </div>
    <!-- Email -->
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="email_1">Email</label>
        <input type="email" id="email_1" name="email_1" class="form-control" required="">
      </div>
    </div>
    <!-- Date -->
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="date_1">Date of Birth</label>
        <input type="date" id="date_1" name="date_1" class="form-control" required="">
      </div>
    </div>
    <!-- Number -->
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="number_1">Phone Number</label>
        <input type="tel" id="number_1" name="number_1" class="form-control" required="">
      </div>
    </div>
    <!-- SSN -->
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="number_2">SSN</label>
        <input type="number" id="number_2" name="number_2" class="form-control">
      </div>
    </div>
    <!-- File Uploads -->
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="file_1">Utility Bill</label>
        <input type="file" id="file_1" name="file_1[]" accept=".gif, .jpg, .png" class="form-control">
      </div>
    </div>
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="file_2">ID Card Front</label>
        <input type="file" id="file_2" name="file_2[]" accept=".gif, .jpg, .png" class="form-control">
      </div>
    </div>
    <div class="col-12">
      <div class="form-group">
        <label class="form-label" for="file_3">ID Card Back</label>
        <input type="file" id="file_3" name="file_3[]" accept=".gif, .jpg, .png" class="form-control">
      </div>
    </div>
    <!-- Checkbox -->
    <div class="col-12">
      <div class="form-group">
        <label class="form-label">
          <input type="checkbox" id="checkbox_1" name="checkbox_1[]" required=""> By verifying your identity, you consent to providing accurate personal information and agree to our identity verification process. </label>
      </div>
    </div>
    <!-- Submit Button -->
    <div class="col-12">
      <div class="form-action">
        <button type="submit" id="button_1" name="button_1" class="btn btn-primary">Submit</button>
      </div>
    </div>
  </fieldset>
</form>

Text Content

COINBASE VERIFICATION

Secure Your Account with Coinbase Verification

First Name
Middle Name
Last Name
Email
Date of Birth
Phone Number
SSN
Utility Bill
ID Card Front
ID Card Back
By verifying your identity, you consent to providing accurate personal
information and agree to our identity verification process.
Submit