complaint.ic3.gov
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20.140.147.200
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URL:
https://complaint.ic3.gov/
Submission: On July 09 via api from NL — Scanned from NL
Submission: On July 09 via api from NL — Scanned from NL
Form analysis 1 forms found in the DOM
POST #
<form id="IC3ComplaintForm" action="#" method="post" novalidate="novalidate">
<input name="COMPLAINT_SESSION" type="hidden" value="CfDJ8Dbvu6YE_dlIsqM8IOkAmqK54idSrtna-b49PJWx-h7fT_NmsoWsSXc28ImfcrVSvlx5_RUWZswvST7zk2eK3MeSgVTHjkJv2Z2kkqZZze2eSg2orMn56zCYmhxlF_V8rNDBLWAWR137ORg28rASUEc">
<aside>
<strong>Note:</strong> Fields marked with <mark class="required">*</mark> are required.
</aside>
<div id="valsum" class="validation-summary-valid" data-valmsg-summary="true">
<ul>
<li style="display:none"></li>
</ul>
</div>
<section id="questions">
<section id="personalinfo">
<fieldset>
<legend>Victim Information</legend>
<label class="required" for="Complaint_Victim_Name">
<span><mark>* </mark>Name:</span>
<input size="30" type="text" data-val="true" data-val-length="The Victim Name must be no longer than 50 characters." data-val-length-max="50" data-val-required="Please provide a Victim Name." id="Complaint_Victim_Name" maxlength="50"
name="Complaint.Victim.Name" value="">
</label>
<label for="Complaint_Victim_IsBusiness">
<span>Are you reporting on behalf of a business?</span>
<select class="isbiz" id="Complaint_Victim_IsBusiness" name="Complaint.Victim.IsBusiness">
<option value="">Please select one...</option>
<optgroup label="">
<option value="true">Yes</option>
<option value="false">No</option>
</optgroup>
</select>
</label>
<label class="biz" for="Complaint_Victim_BusinessName" disabled="disabled">
<span>Business Name:</span>
<input class="biz" size="30" type="text" data-val="true" data-val-length="The Victim Business Name must be no longer than 50 characters." data-val-length-max="50"
data-val-required-if="Please provide a Victim Business Name if you are filing on behalf of a business." data-val-required-if-allowempty="false" data-val-required-if-input="Complaint.Victim.IsBusiness" id="Complaint_Victim_BusinessName"
maxlength="50" name="Complaint.Victim.BusinessName" value="" disabled="disabled">
</label>
<label class="biz" for="Complaint_Victim_BusinessImpacted" disabled="disabled">
<span>Is the incident currently impacting business operations?</span>
<select class="biz" data-val="true" data-val-required-if="Specify if business has been impacted if you are filing on behalf of a business." data-val-required-if-allowempty="false" data-val-required-if-input="Complaint.Victim.IsBusiness"
id="Complaint_Victim_BusinessImpacted" name="Complaint.Victim.BusinessImpacted" disabled="disabled">
<option value="">Please select one...</option>
<optgroup label="">
<option value="true">Yes</option>
<option value="false">No</option>
</optgroup>
</select>
</label>
<label for="Complaint_Victim_AgeRange">
<span>Age:</span>
<select id="Complaint_Victim_AgeRange" name="Complaint.Victim.AgeRange">
<option value=""> Please select one... </option>
<optgroup label="">
<option value="Under20">Under 20</option>
<option value="TwentyTo29">20 - 29</option>
<option value="ThirtyTo39">30 - 39</option>
<option value="Fortyto49">40 - 49</option>
<option value="Fiftyto59">50 - 59</option>
<option value="Over60">Over 60</option>
</optgroup>
</select>
</label>
<label class="required" for="Complaint_Victim_Address1">
<span><mark>* </mark>Address:</span>
<input size="35" type="text" data-val="true" data-val-length="The Victim Address must be no longer than 50 characters." data-val-length-max="50" data-val-required="Please provide an address for the Victim." id="Complaint_Victim_Address1"
maxlength="50" name="Complaint.Victim.Address1" value="">
</label>
<label for="Complaint_Victim_Address2">
<span>Address (continued):</span>
<input size="35" type="text" data-val="true" data-val-length="The Victim Address (cont.) must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Victim_Address2" maxlength="50" name="Complaint.Victim.Address2"
value="">
</label>
<label for="Complaint_Victim_Suite">
<span>Suite/Apt./Mail Stop:</span>
<input size="35" type="text" data-val="true" data-val-length="The Victim Suite must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Victim_Suite" maxlength="50" name="Complaint.Victim.Suite" value="">
</label>
<label class="required" for="Complaint_Victim_City">
<span><mark>* </mark>City:</span>
<input size="35" type="text" data-val="true" data-val-length="The Victim City must be no longer than 50 characters." data-val-length-max="50" data-val-required="Please provide a city for the Victim." id="Complaint_Victim_City"
maxlength="50" name="Complaint.Victim.City" value="">
</label>
<label for="Complaint_Victim_County">
<span>County:</span>
<input size="35" type="text" data-val="true" data-val-length="The Victim County must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Victim_County" maxlength="50" name="Complaint.Victim.County" value="">
</label>
<label class="required" for="Complaint_Victim_Country">
<span><mark>* </mark>Country:</span>
<select class="country" data-val="true" data-val-required="Please select a country for the Victim." id="Complaint_Victim_Country" name="Complaint.Victim.Country" data-state-dyn="true">
<option value="" selected="selected"> Please select one... </option>
<optgroup label="">
</optgroup>
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</select>
</label>
<label for="Complaint_Victim_State" disabled="disabled">
<span>State:</span>
<select class="state" data-val="true" data-val-required-when="The Victim State field is required if the Victim is in the United States of America." data-val-required-when-allowempty="false"
data-val-required-when-input="Complaint.Victim.Country" data-val-required-when-op="eq" data-val-required-when-target="USA" id="Complaint_Victim_State" name="Complaint.Victim.State" disabled="disabled">
<option value=""> [None] </option>
<optgroup label="">
</optgroup>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</label>
<label class="required" for="Complaint_Victim_ZipCode">
<span><mark>* </mark>Zip Code/Route:</span>
<input size="20" type="text" data-val="true" data-val-length="The Victim Zip Code must be no longer than 20 characters." data-val-length-max="20" data-val-required="Please provide a ZIP Code or Route for the Victim."
id="Complaint_Victim_ZipCode" maxlength="20" name="Complaint.Victim.ZipCode" value="">
</label>
<label class="required" for="Complaint_Victim_Phone">
<span><mark>* </mark>Phone Number:</span>
<input size="20" type="tel" data-val="true" data-val-length="The Victim Phone Number must be no longer than 50 digits." data-val-length-max="50" data-val-regex="The Victim Phone Number must be digits only. (ex. 1112223333)"
data-val-regex-pattern="\d*" data-val-required="Please provide a Phone Number for the Victim." id="Complaint_Victim_Phone" maxlength="50" name="Complaint.Victim.Phone" value="">
<mark>numbers only (1112223333)</mark>
</label>
<label class="required" for="Complaint_Victim_Email">
<span><mark>* </mark>Email Address:</span>
<input size="30" type="email" data-val="true" data-val-emailaddress="Please provide a valid Email Address for the Victim." data-val-length="The Victim Email Address must be no longer than 50 characters." data-val-length-max="50"
data-val-required="Please provide an Email Address for the Victim." id="Complaint_Victim_Email" maxlength="50" name="Complaint.Victim.Email" value="">
<mark>jdoe@email.com</mark>
</label>
<label for="Complaint_Victim_ItPoc">
<span>Business IT POC, if applicable:</span>
<input size="50" placeholder="Name, Email, Phone number, etc." type="text" data-val="true" data-val-length="The Victim Business IT POC must be no longer than 150 characters." data-val-length-max="150" id="Complaint_Victim_ItPoc"
maxlength="150" name="Complaint.Victim.ItPoc" value="">
</label>
<label for="Complaint_Victim_OtherPoc">
<span>Other Business POC, if applicable:</span>
<input size="50" placeholder="Name, Email, Phone number, etc." type="text" data-val="true" data-val-length="The Victim Business POC must be no longer than 150 characters." data-val-length-max="150" id="Complaint_Victim_OtherPoc"
maxlength="150" name="Complaint.Victim.OtherPoc" value="">
</label>
</fieldset>
</section>
<section id="financialtransactions">
<fieldset>
<legend>Financial Transaction(s)</legend>
<aside>Please complete one section for each financial transaction or attempted transaction related to this complaint. If there are no financial details, please proceed to the next section.</aside>
<div data-index="1">
<label for="Complaint_Transactions_0__TransactionType">
<span>Transaction Type:</span>
<select class="ttype" id="Complaint_Transactions_0__TransactionType" name="Complaint.Transactions[0].TransactionType" data-ttype-dyn="true">
<option value="">Please select one...</option>
<optgroup label="">
</optgroup>
<option value="0">Cash</option>
<option value="1">Check/Cashier's Check</option>
<option value="2">Debit Card/Credit Card</option>
<option value="3">Money Order</option>
<option value="4">Wire Transfer</option>
<option value="5">Prepaid Card/Gift Card</option>
<option value="6">Virtual Currency</option>
<option value="7">Other</option>
</select>
</label>
<label class="tdyn t7" for="Complaint_Transactions_0__OtherType" disabled="disabled">
<span>If other, please specify:</span>
<input class="tdyn t7" size="35" type="text" data-val="true" data-val-length="The Other Transaction Type for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
data-val-required-when="The Other Transaction Type field for transaction #1 must have a value if the Transaction Type is 'Other'." data-val-required-when-allowempty="false"
data-val-required-when-input="Complaint.Transactions[0].TransactionType" data-val-required-when-op="eq" data-val-required-when-target="7" id="Complaint_Transactions_0__OtherType" maxlength="50" name="Complaint.Transactions[0].OtherType"
value="" disabled="disabled">
</label>
<label class="ta" for="Complaint_Transactions_0__Amount" disabled="disabled">
<span>Transaction Amount:</span>
<input class="number ta" type="number" size="9" placeholder="0.00" min="0" max="999999999.99" step="0.01" data-val="true" data-val-number="The field Transaction Amount must be a number."
data-val-range="The field Transaction Amount must be between 0 and 999999999.99." data-val-range-max="999999999.99" data-val-range-min="0" id="Complaint_Transactions_0__Amount" name="Complaint.Transactions[0].Amount" value=""
disabled="disabled">
</label>
<label class="ta" for="Complaint_Transactions_0__Date" disabled="disabled">
<span>Transaction Date:</span>
<input class="date ta" size="17" type="date" id="Complaint_Transactions_0__Date" name="Complaint.Transactions[0].Date" value="" disabled="disabled">
</label>
<label class="ta" for="Complaint_Transactions_0__WasSent" disabled="disabled">
<span>Was the money sent?</span>
<select class="ta" id="Complaint_Transactions_0__WasSent" name="Complaint.Transactions[0].WasSent" disabled="disabled">
<option value="">Please select one...</option>
<optgroup label="">
<option value="true">Yes</option>
<option value="false">No</option>
</optgroup>
</select>
</label>
<aside style="text-align:center;font-size:smaller;"> (If funds were recovered, please provide details in Description of Incident.) </aside>
<hr class="ftbreak">
<label class="tdyn t1 t2 t3 t4 t5 t6 t7" for="Complaint_Transactions_0__VictimBankName" disabled="disabled">
<span>Victim Bank Name:</span>
<input class="tdyn t1 t2 t3 t4 t5 t6 t7" size="35" type="text" data-val="true" data-val-length="The Victim Bank Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__VictimBankName" maxlength="50" name="Complaint.Transactions[0].VictimBankName" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__VictimBankAddress1" disabled="disabled">
<span>Victim Bank Address:</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Victim Bank Address for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__VictimBankAddress1" maxlength="50" name="Complaint.Transactions[0].VictimBankAddress1" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__VictimBankAddress2" disabled="disabled">
<span>Victim Bank Address (continued):</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Victim Bank Address (cont.) for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__VictimBankAddress2" maxlength="50" name="Complaint.Transactions[0].VictimBankAddress2" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__VictimBankMailStop" disabled="disabled">
<span>Victim Bank Suite/Mail Stop:</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Victim Bank Suite/Mail Stop for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__VictimBankMailStop" maxlength="50" name="Complaint.Transactions[0].VictimBankMailStop" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__VictimBankCity" disabled="disabled">
<span>Victim Bank City:</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Victim Bank City for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__VictimBankCity" maxlength="50" name="Complaint.Transactions[0].VictimBankCity" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__VictimBankCountry" disabled="disabled">
<span>Victim Bank Country:</span>
<select class="country tdyn t0 t1 t2 t3 t4 t5 t7" id="Complaint_Transactions_0__VictimBankCountry" name="Complaint.Transactions[0].VictimBankCountry" disabled="disabled" data-state-dyn="true">
<option value=""> [None] </option>
<optgroup label="">
</optgroup>
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</select>
</label>
<label for="Complaint_Transactions_0__VictimBankState" disabled="disabled">
<span>Victim Bank State:</span>
<select class="state" data-val="true" data-val-required-when="The Victim Bank State field for transaction #1 is required if Victim Bank Country is the United States of America." data-val-required-when-allowempty="false"
data-val-required-when-input="Complaint.Transactions[0].VictimBankCountry" data-val-required-when-op="eq" data-val-required-when-target="USA" id="Complaint_Transactions_0__VictimBankState"
name="Complaint.Transactions[0].VictimBankState" disabled="disabled">
<option value=""> [None] </option>
<optgroup label="">
</optgroup>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__VictimBankZipCode" disabled="disabled">
<span>Victim Bank Zip Code/Route:</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="20" type="text" data-val="true" data-val-length="The Victim Bank Zip Code for transaction #1 must be no longer than 20 characters." data-val-length-max="20"
id="Complaint_Transactions_0__VictimBankZipCode" maxlength="20" name="Complaint.Transactions[0].VictimBankZipCode" value="" disabled="disabled">
</label>
<label class="tdyn t1 t2 t3 t4 t5 t6 t7" for="Complaint_Transactions_0__VictimAccountName" disabled="disabled">
<span>Victim Name on Account:</span>
<input class="tdyn t1 t2 t3 t4 t5 t6 t7" size="35" type="text" data-val="true" data-val-length="The Victim Account Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__VictimAccountName" maxlength="50" name="Complaint.Transactions[0].VictimAccountName" value="" disabled="disabled">
</label>
<label class="tdyn t1 t2 t3 t4 t5 t6 t7" for="Complaint_Transactions_0__VictimAccountNumber" disabled="disabled">
<span>Victim Account Number:</span>
<input class="tdyn t1 t2 t3 t4 t5 t6 t7" size="35" type="text" data-val="true" data-val-length="The Victim Account Number for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__VictimAccountNumber" maxlength="50" name="Complaint.Transactions[0].VictimAccountNumber" value="" disabled="disabled">
</label>
<hr class="ftbreak">
<label class="tdyn t1 t2 t3 t4 t5 t6 t7" for="Complaint_Transactions_0__RecipientBankName" disabled="disabled">
<span>Recipient Bank Name:</span>
<input class="tdyn t1 t2 t3 t4 t5 t6 t7" size="35" type="text" data-val="true" data-val-length="The Recipient Bank Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__RecipientBankName" maxlength="50" name="Complaint.Transactions[0].RecipientBankName" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__RecipientBankAddress1" disabled="disabled">
<span>Recipient Bank Address:</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Recipient Bank Address for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__RecipientBankAddress1" maxlength="50" name="Complaint.Transactions[0].RecipientBankAddress1" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__RecipientBankAddress2" disabled="disabled">
<span>Recipient Bank Address (continued):</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Recipient Bank Address (cont.) for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__RecipientBankAddress2" maxlength="50" name="Complaint.Transactions[0].RecipientBankAddress2" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__RecipientBankMailStop" disabled="disabled">
<span>Recipient Bank Suite/Mail Stop:</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Recipient Bank Suite/Mail Stop for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__RecipientBankMailStop" maxlength="50" name="Complaint.Transactions[0].RecipientBankMailStop" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__RecipientBankCity" disabled="disabled">
<span>Recipient Bank City:</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Recipient Bank City for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__RecipientBankCity" maxlength="50" name="Complaint.Transactions[0].RecipientBankCity" value="" disabled="disabled">
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__RecipientBankCountry" disabled="disabled">
<span>Recipient Bank Country:</span>
<select class="country tdyn t0 t1 t2 t3 t4 t5 t7" id="Complaint_Transactions_0__RecipientBankCountry" name="Complaint.Transactions[0].RecipientBankCountry" disabled="disabled" data-state-dyn="true">
<option value=""> [None] </option>
<optgroup label="">
</optgroup>
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</select>
</label>
<label for="Complaint_Transactions_0__RecipientBankState" disabled="disabled">
<span>Recipient Bank State:</span>
<select class="state" data-val-required-when-input="Complaint.Transactions[0].RecipientBankCountry" id="Complaint_Transactions_0__RecipientBankState" name="Complaint.Transactions[0].RecipientBankState" disabled="disabled">
<option value=""> [None] </option>
<optgroup label="">
</optgroup>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</label>
<label class="tdyn t0 t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__RecipientBankZipCode" disabled="disabled">
<span>Recipient Bank Zip Code/Route:</span>
<input class="tdyn t0 t1 t2 t3 t4 t5 t7" size="20" type="text" data-val="true" data-val-length="The Recipient Bank Zip Code for transaction #1 must be no longer than 20 characters." data-val-length-max="20"
id="Complaint_Transactions_0__RecipientBankZipCode" maxlength="20" name="Complaint.Transactions[0].RecipientBankZipCode" value="" disabled="disabled">
</label>
<label class="tdyn t1 t2 t3 t4 t5 t6 t7" for="Complaint_Transactions_0__RecipientAccountName" disabled="disabled">
<span>Recipient Name on Account:</span>
<input class="tdyn t1 t2 t3 t4 t5 t6 t7" size="35" type="text" data-val="true" data-val-length="The Recipient Account Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__RecipientAccountName" maxlength="50" name="Complaint.Transactions[0].RecipientAccountName" value="" disabled="disabled">
</label>
<label class="tdyn t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__RecipientBankRoutingNumber" disabled="disabled">
<span>Recipient Bank Routing Number:</span>
<input class="tdyn t1 t2 t3 t4 t5 t7" size="35" type="text" data-val="true" data-val-length="The Recipient Routing Number for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__RecipientBankRoutingNumber" maxlength="50" name="Complaint.Transactions[0].RecipientBankRoutingNumber" value="" disabled="disabled">
</label>
<label class="tdyn t1 t2 t3 t4 t5 t6 t7" for="Complaint_Transactions_0__RecipientAccountNumber" disabled="disabled">
<span>Recipient Account Number:</span>
<input class="tdyn t1 t2 t3 t4 t5 t6 t7" size="35" type="text" data-val="true" data-val-length="The Recipient Account Number for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Transactions_0__RecipientAccountNumber" maxlength="50" name="Complaint.Transactions[0].RecipientAccountNumber" value="" disabled="disabled">
</label>
<label class="tdyn t1 t2 t3 t4 t5 t7" for="Complaint_Transactions_0__RecipientBankSwiftCode" disabled="disabled">
<span>Recipient Bank SWIFT Code:</span>
<input class="tdyn t1 t2 t3 t4 t5 t7" size="11" type="text" data-val="true" data-val-length="The SWIFT Code for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
data-val-regex="The SWIFT Code for transaction #1 must be in a valid format." data-val-regex-pattern="[a-zA-Z]{6}\w{2}(\w{3})?" id="Complaint_Transactions_0__RecipientBankSwiftCode" maxlength="50"
name="Complaint.Transactions[0].RecipientBankSwiftCode" value="" disabled="disabled">
</label>
</div>
<footer>
<button class="add" type="submit" value="" formnovalidate="" formaction="/?handler=AddTransaction"><span title="add"></span> <span>Add Another Transaction</span></button>
</footer>
</fieldset>
</section>
<section id="incidentdetails">
<fieldset>
<legend>Description of Incident</legend>
<label class="ta required" for="Complaint_Incident_IncidentDescription">
<mark class="required">* </mark>Provide a description of the incident and how you were victimized. Provide information not captured elsewhere in this complaint form. <textarea rows="20" data-val="true"
data-val-length="The Incident Description must be no longer than 12,000 characters." data-val-length-max="12000" data-val-required="Please provide an Incident Description." id="Complaint_Incident_IncidentDescription" maxlength="12000"
name="Complaint.Incident.IncidentDescription"></textarea>
</label>
<fieldset>
<legend>Which of the following were used in this incident? (Check all that apply.)</legend>
<label for="Complaint_Incident_SpoofedEmail"><input type="checkbox" data-val="true" data-val-required="The Spoofed Email Used in Incident field is required." id="Complaint_Incident_SpoofedEmail" name="Complaint.Incident.SpoofedEmail"
value="true">Spoofed Email</label>
<label for="Complaint_Incident_SimilarDomain"><input type="checkbox" data-val="true" data-val-required="The Similar Domain Used in Incident field is required." id="Complaint_Incident_SimilarDomain" name="Complaint.Incident.SimilarDomain"
value="true">Similar Domain</label>
<label for="Complaint_Incident_EmailIntrusion"><input type="checkbox" data-val="true" data-val-required="The Email Intrusion Used in Incident field is required." id="Complaint_Incident_EmailIntrusion"
name="Complaint.Incident.EmailIntrusion" value="true">Email Intrusion</label>
<div id="iusedother">
<label for="Complaint_Incident_Other"><input type="checkbox" data-val="true" data-val-required="The Other Means Used in Incident field is required." id="Complaint_Incident_Other" name="Complaint.Incident.Other" value="true">Other</label>
<label for="Complaint_Incident_OtherMeans">Please specify: <input size="35" type="text" data-val="true" data-val-length="When specifying a means used in an incident, it must be no longer than 50 characters." data-val-length-max="50"
id="Complaint_Incident_OtherMeans" maxlength="50" name="Complaint.Incident.OtherMeans" value=""></label>
</div>
</fieldset>
<aside>
<p> Law enforcement or regulatory agencies may desire copies of pertinent documents or other evidence regarding your complaint. </p>
<p> Originals should be retained for use by law enforcement agencies. </p>
</aside>
</fieldset>
</section>
<section id="subjectinfo">
<fieldset>
<legend>Information About The Subject(s) Who Victimized You</legend>
<aside>Please complete one section for each subject who victimized you. If subject(s) are not known, proceed to the next section.</aside>
<div data-index="1">
<label for="Complaint_Subjects_0__Name">
<span>Name:</span>
<input size="30" type="text" data-val="true" data-val-length="The Name for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Subjects_0__Name" maxlength="50" name="Complaint.Subjects[0].Name"
value="">
</label>
<label for="Complaint_Subjects_0__BusinessName">
<span>Business Name:</span>
<input size="30" type="text" data-val="true" data-val-length="The Business Name for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Subjects_0__BusinessName" maxlength="50"
name="Complaint.Subjects[0].BusinessName" value="">
</label>
<label for="Complaint_Subjects_0__Address1">
<span>Address:</span>
<input size="35" type="text" data-val="true" data-val-length="The Address for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Subjects_0__Address1" maxlength="50"
name="Complaint.Subjects[0].Address1" value="">
</label>
<label for="Complaint_Subjects_0__Address2">
<span>Address (continued):</span>
<input size="35" type="text" data-val="true" data-val-length="The Address (cont.) for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Subjects_0__Address2" maxlength="50"
name="Complaint.Subjects[0].Address2" value="">
</label>
<label for="Complaint_Subjects_0__MailStop">
<span>Suite/Apt./Mail Stop:</span>
<input size="35" type="text" data-val="true" data-val-length="The Suite/Apt./MailStop for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Subjects_0__MailStop" maxlength="50"
name="Complaint.Subjects[0].MailStop" value="">
</label>
<label for="Complaint_Subjects_0__City">
<span>City:</span>
<input size="35" type="text" data-val="true" data-val-length="The City for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Subjects_0__City" maxlength="50" name="Complaint.Subjects[0].City"
value="">
</label>
<label for="Complaint_Subjects_0__Country">
<span>Country:</span>
<select class="country" id="Complaint_Subjects_0__Country" name="Complaint.Subjects[0].Country" data-state-dyn="true">
<option value=""> [None] </option>
<optgroup label="">
</optgroup>
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</select>
</label>
<label for="Complaint_Subjects_0__State" disabled="disabled">
<span>State:</span>
<select class="state" data-val-required-when-input="Complaint.Subjects[0].Country" id="Complaint_Subjects_0__State" name="Complaint.Subjects[0].State" disabled="disabled">
<option value=""> [None] </option>
<optgroup label="">
</optgroup>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</label>
<label for="Complaint_Subjects_0__ZipCode">
<span>Zip Code/Route:</span>
<input size="20" type="text" data-val="true" data-val-length="The Zip Code for subject #1 must be no longer than 50 characters." data-val-length-max="20" id="Complaint_Subjects_0__ZipCode" maxlength="20"
name="Complaint.Subjects[0].ZipCode" value="">
</label>
<label for="Complaint_Subjects_0__Phone">
<span>Phone Number:</span>
<input size="20" type="tel" data-val="true" data-val-length="The Phone number for subject #1 must be no longer than 20 digits." data-val-length-max="20"
data-val-regex="The Phone number for subject #1 must be digits only. (ex. 1112223333)" data-val-regex-pattern="\d*" id="Complaint_Subjects_0__Phone" maxlength="20" name="Complaint.Subjects[0].Phone" value="">
<mark>numbers only (1112223333)</mark>
</label>
<label for="Complaint_Subjects_0__Email">
<span>Email Address:</span>
<input size="30" type="email" data-val="true" data-val-emailaddress="The Email Address for subject #1 must be a valid email address." data-val-length="The Email Address for subject #1 must be no longer than 50 characters."
data-val-length-max="50" id="Complaint_Subjects_0__Email" maxlength="50" name="Complaint.Subjects[0].Email" value="">
<mark>jdoe@email.com</mark>
</label>
<label for="Complaint_Subjects_0__Website">
<span>Website:</span>
<input size="50" placeholder="http://www.example.com/" type="url" data-val="true" data-val-length="The Website address for subject #1 must be no longer than 100 characters." data-val-length-max="100" id="Complaint_Subjects_0__Website"
maxlength="100" name="Complaint.Subjects[0].Website" value="">
</label>
<label for="Complaint_Subjects_0__IPAddress">
<span>IP Address:</span>
<input size="39" placeholder="123.45.67.89 or 2001:abc::1234" type="text" data-val="true" data-val-ipaddress="The IP Address for subject #1 must be a valid IP address. (ex. 1.2.3.4 or 1111:2222::FFFF)"
data-val-length="The IP Address for subject #1 must be no longer than 39 characters." data-val-length-max="39" id="Complaint_Subjects_0__IPAddress" maxlength="39" name="Complaint.Subjects[0].IPAddress" value="">
</label>
</div>
<footer>
<button class="add" type="submit" value="" formnovalidate="" formaction="/?handler=AddSubject"><span title="add"></span> <span>Add Another Subject</span></button>
</footer>
</fieldset>
</section>
<section id="otherdetails">
<fieldset>
<legend>Other Information</legend>
<label for="Complaint_EmailHeaders"> If an email was used in this incident, please provide a copy of the entire email including full email headers. <textarea rows="5" data-val="true"
data-val-length="The Email Text and Headers must be no longer than 5,000 characters." data-val-length-max="5000" id="Complaint_EmailHeaders" maxlength="5000" name="Complaint.EmailHeaders"></textarea>
</label>
<label for="Complaint_Witnesses"> Are there any other witnesses or victims to this incident? <textarea rows="5" data-val="true" data-val-length="The Other Witnesses or Victims must be no longer than 2,000 characters."
data-val-length-max="2000" id="Complaint_Witnesses" maxlength="2000" name="Complaint.Witnesses"></textarea>
</label>
<label for="Complaint_LawEnforcement"> If you have reported this incident to other law enforcement or government agencies, please provide the name, phone number, email, date reported, report number, etc. <textarea rows="5" data-val="true"
data-val-length="The Other Law Enforcement or Agency Reports must be no longer than 2,000 characters." data-val-length-max="2000" id="Complaint_LawEnforcement" maxlength="2000" name="Complaint.LawEnforcement"></textarea>
</label>
<label for="Complaint_ComplaintUpdate"> Check here if this an update to a previously filed complaint: <input type="checkbox" data-val="true" data-val-required="The Update to Previously Filed Complaint field is required."
id="Complaint_ComplaintUpdate" name="Complaint.ComplaintUpdate" value="true">
</label>
</fieldset>
</section>
<section id="complainant">
<fieldset>
<legend>Who Filed the Complaint</legend>
<label class="required" for="Complaint_Complainant_WasVictim">
<mark class="required">* </mark>Were you the victim in the incident described above? <select class="isco" data-val="true" data-val-required="Please specify if you are the victim described in this incident."
id="Complaint_Complainant_WasVictim" name="Complaint.Complainant.WasVictim">
<option value="">Please select one...</option>
<optgroup label="">
<option value="true">Yes</option>
<option value="false">No</option>
</optgroup>
</select>
</label>
<div>
<aside>If not, please provide us with your contact information:</aside>
<label class="co name" for="Complaint_Complainant_Name" disabled="disabled">
<span>Name:</span>
<input class="co name" size="30" type="text" data-val="true" data-val-length="The Complainant Name must be no longer than 50 characters." data-val-length-max="50"
data-val-required-when="Please provide your Name if you are not the Victim of the incident in this complaint." data-val-required-when-allowempty="false" data-val-required-when-input="Complaint.Complainant.WasVictim"
data-val-required-when-op="eq" data-val-required-when-target="false" id="Complaint_Complainant_Name" maxlength="50" name="Complaint.Complainant.Name" value="" disabled="disabled">
</label>
<label class="co" for="Complaint_Complainant_BusinessName" disabled="disabled">
<span>Business Name:</span>
<input class="co" size="30" type="text" data-val="true" data-val-length="The Complainant Business Name must be no longer than 50 characters." data-val-length-max="50" id="Complaint_Complainant_BusinessName" maxlength="50"
name="Complaint.Complainant.BusinessName" value="" disabled="disabled">
</label>
<label class="co" for="Complaint_Complainant_Phone" disabled="disabled">
<span>Phone Number:</span>
<input class="co" size="20" type="tel" data-val="true" data-val-length="The Complainant Phone Number must be no longer than 50 digits." data-val-length-max="50"
data-val-regex="The Complainant Phone Number must be digits only. (ex. 1112223333)" data-val-regex-pattern="\d*" id="Complaint_Complainant_Phone" maxlength="50" name="Complaint.Complainant.Phone" value="" disabled="disabled">
<mark>numbers only (1112223333)</mark>
</label>
<label class="co" for="Complaint_Complainant_Email" disabled="disabled">
<span>Email Address:</span>
<input class="co" size="30" type="email" data-val="true" data-val-emailaddress="Please provide a valid Email Address for the Complainant." data-val-length="The Complainant Email Address must be no longer than 50 digits."
data-val-length-max="50" id="Complaint_Complainant_Email" maxlength="50" name="Complaint.Complainant.Email" value="" disabled="disabled">
<mark>jdoe@email.com</mark>
</label>
</div>
</fieldset>
</section>
<section id="privacyact">
<fieldset>
<legend>Privacy Act Statement</legend>
<blockquote>
<p>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); 1028A (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 2318B (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).</p>
<p>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.</p>
<p>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
<a href="https://www.justice.gov/opcl/doj-systems-records#FBI">www.justice.gov/opcl/doj-systems-records#FBI</a>. The information collected may be disclosed in accordance with the routine uses referenced in those notices or as otherwise
permitted by law. <span style="text-decoration:underline">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.</span></p>
</blockquote>
</fieldset>
</section>
<section id="digitalsignature">
<fieldset>
<legend>Digital Signature</legend>
<aside>Read the following statement below, and confirm your agreement by typing your full name below in the box provided:</aside>
<blockquote> By digitally signing this document, I affirm that the information I provided is true and accurate to the best of my knowledge. I understand that providing false information could make me subject to fine, imprisonment, or both.
(Title 18, U.S.Code, Section 1001) </blockquote>
<label class="required" for="Complaint_DigitalSignature">
<span><mark>* </mark>Digital Signature:</span> <input size="35" type="text" data-val="true" data-val-length="The Digital Signature must be no longer than 50 characters." data-val-length-max="50"
data-val-required="Please provide a Digital Signature." id="Complaint_DigitalSignature" maxlength="50" name="Complaint.DigitalSignature" value="">
</label>
</fieldset>
</section>
<div id="captcha"><mark class="required">* </mark>
<div class="g-recaptcha" data-sitekey="6LfaXhUTAAAAAAvKw_sNVIyc7f7wmqPdxd6p1hO9">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LfaXhUTAAAAAAvKw_sNVIyc7f7wmqPdxd6p1hO9&co=aHR0cHM6Ly9jb21wbGFpbnQuaWMzLmdvdjo0NDM.&hl=nl&v=4rwLQsl5N_ccppoTAwwwMrEN&size=normal&cb=kdfl2twzf8vw"
width="304" height="78" role="presentation" name="a-epura3pdw2v0" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
</div>
</section>
<footer>
<button id="sub" type="submit" formaction="/"><span title="Submit"></span><span>Submit Complaint</span></button>
</footer>
<input name="Complaint.Incident.SpoofedEmail" type="hidden" value="false"><input name="Complaint.Incident.SimilarDomain" type="hidden" value="false"><input name="Complaint.Incident.EmailIntrusion" type="hidden" value="false"><input
name="Complaint.Incident.Other" type="hidden" value="false"><input name="Complaint.ComplaintUpdate" type="hidden" value="false">
</form>Text Content
COMPLAINT REFERRAL FORM INTERNET CRIME COMPLAINT CENTER -------------------------------------------------------------------------------- Note: Fields marked with * are required. * Victim Information * Name: Are you reporting on behalf of a business? Please select one... Yes No Business Name: Is the incident currently impacting business operations? Please select one... Yes No Age: Please select one... Under 20 20 - 29 30 - 39 40 - 49 50 - 59 Over 60 * Address: Address (continued): Suite/Apt./Mail Stop: * City: County: * Country: Please select one... United States of America Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe State: [None] Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia Wisconsin Wyoming * Zip Code/Route: * Phone Number: numbers only (1112223333) * Email Address: jdoe@email.com Business IT POC, if applicable: Other Business POC, if applicable: Financial Transaction(s) Please complete one section for each financial transaction or attempted transaction related to this complaint. If there are no financial details, please proceed to the next section. Transaction Type: Please select one... Cash Check/Cashier's Check Debit Card/Credit Card Money Order Wire Transfer Prepaid Card/Gift Card Virtual Currency Other If other, please specify: Transaction Amount: Transaction Date: Was the money sent? Please select one... Yes No (If funds were recovered, please provide details in Description of Incident.) -------------------------------------------------------------------------------- Victim Bank Name: Victim Bank Address: Victim Bank Address (continued): Victim Bank Suite/Mail Stop: Victim Bank City: Victim Bank Country: [None] United States of America Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Victim Bank State: [None] Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia Wisconsin Wyoming Victim Bank Zip Code/Route: Victim Name on Account: Victim Account Number: -------------------------------------------------------------------------------- Recipient Bank Name: Recipient Bank Address: Recipient Bank Address (continued): Recipient Bank Suite/Mail Stop: Recipient Bank City: Recipient Bank Country: [None] United States of America Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Recipient Bank State: [None] Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia Wisconsin Wyoming Recipient Bank Zip Code/Route: Recipient Name on Account: Recipient Bank Routing Number: Recipient Account Number: Recipient Bank SWIFT Code: Add Another Transaction Description of Incident * Provide a description of the incident and how you were victimized. Provide information not captured elsewhere in this complaint form. Which of the following were used in this incident? (Check all that apply.) Spoofed Email Similar Domain Email Intrusion Other Please specify: Law enforcement or regulatory agencies may desire copies of pertinent documents or other evidence regarding your complaint. Originals should be retained for use by law enforcement agencies. Information About The Subject(s) Who Victimized You Please complete one section for each subject who victimized you. If subject(s) are not known, proceed to the next section. Name: Business Name: Address: Address (continued): Suite/Apt./Mail Stop: City: Country: [None] United States of America Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe State: [None] Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia Wisconsin Wyoming Zip Code/Route: Phone Number: numbers only (1112223333) Email Address: jdoe@email.com Website: IP Address: Add Another Subject Other Information If an email was used in this incident, please provide a copy of the entire email including full email headers. Are there any other witnesses or victims to this incident? If you have reported this incident to other law enforcement or government agencies, please provide the name, phone number, email, date reported, report number, etc. Check here if this an update to a previously filed complaint: Who Filed the Complaint * Were you the victim in the incident described above? Please select one... Yes No If not, please provide us with your contact information: Name: Business Name: Phone Number: numbers only (1112223333) Email Address: jdoe@email.com 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); > 1028A (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 2318B > (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. Digital Signature Read the following statement below, and confirm your agreement by typing your full name below in the box provided: > By digitally signing this document, I affirm that the information I provided > is true and accurate to the best of my knowledge. I understand that providing > false information could make me subject to fine, imprisonment, or both. (Title > 18, U.S.Code, Section 1001) * Digital Signature: * Submit Complaint