Know Your Client (KYC) Form

To assist you develop the best strategy to recover your money, kindly fill in this form electronically and share
with us in word format through email at info@tandhconsult.com.
Remember that the more information you provide us, the better we can understand and work on your case. If
you need any assistance in completing this form, do not hesitate to call us on +36 1 408 8556.

Part 1. Personal Information

Full name

Email

Phone

Address

Date of
Birth

Citizenshi
p

Gender

How
would
you like
to be
addressed
Ms /Mrs /
Mr

Part 2. Company/suspect information

What did the fraud relate to?

Investment / Recovery of funds / Dating scam /
Buying selling / Other

Name of the scam company(s) /

individual

Website of the scam company(s) /

individual

Where is the company/individual

from?

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Know Your Client (KYC) Form
Is this company regulated by any
authority?
If yes, please, indicate the authority

How did they find you?

Cold calls / Email / Instagram / Facebook /
LinkedIn / Tinder/ Other (specify)

How did they communicate with you?

Phone calls / Messaging Apps / Emails /
Social Media

When did the company first contact

you?

When was the last time you were

contacted by this company?

Which documents were received and

signed by you?
Agreement / Invoice / DOD / KYC…

Which service or product you were

trying to obtain?
Cryptocurrency / Investment /Other (specify)

What was promised to you by the

company?
Profits / withdrawal / Other (specify)

Who was in contact with you?

Name, position, contact details (email, phone
number, IG…)

Did they use any remote desktop

application?
TeamViewer / AnyDesk / other (specify)

If yes, specify the customer ID/number and

the dates

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Know Your Client (KYC) Form
Is your account with the company still
active?
If yes, please attach the link (URL) you used
to log in

Do you have any available balance on

the platform?
If yes, how much?

Did you receive any credits/loans

from the company?

In case if you received any

credits/loans, did you sign any
agreement upon receiving them?
If yes, what document(s)?

Part 3. Payment Details

In which time range the transactions

were performed? (day, month, year)

What is the full amount of loss?

In what currency?

Who is the owner of the bank account

used?
If applicable, please specify their names and
relationship to you

In case of Payment please indicate the

Payment mode
Credit card / Wire transfer / Crypto / Other

Indicate the type of bank account that

you used
Personal / corporate / joint

In case of Credit Card Transaction,

please indicate:
1. Card-issuing bank
2. Type of Card (MasterCard /

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Know Your Client (KYC) Form
Visa / Maestro)

3. Last 4 digits of your card

number

In case of Credit Card Transaction,

did you have to confirm the
payments?
Received an SMS code / called the bank / the
bank called you / other (specify)

In case of a Wire transaction, please

indicate:
1. Name of your bank
2. Number of your account

In case of Cryptocurrency
Transaction, please indicate:
1. Name of the platform where
you purchased and kept your
cryptocurrency
2. Type of currency (BTC / ETH/
USDT…)

Have you tried a chargeback/recall

process with your bank?
If so, what was the result?
No reply, denied, recovered, under investigation
by the bank…

Part 4. Check-list
Did any of the following happen? Highlight the answer which applies to your case.

Yes / You transferred money Yes /

Did it start with a cold call?
No somewhere. No

Did you send a complaint Yes / Money was taken/debited Yes /

to the seller? No from your account. No

Do you have Yes / You handed over a card, Yes /

correspondence with the No disclosed a PIN or other No

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Know Your Client (KYC) Form
security code.
seller?
Specify:

You have been contacted

Did you ask for a Yes / Yes /
more than once by the
withdrawal? No No
same person.

Have you tried to resolve Yes / Yes /

Did you contact your bank?
the conflict? No No

Yes /
Did you try to process a
No
chargeback through your
bank?
Did you leave negative Yes /
feedback about the seller? No

(if yes, please specify

_______
when)
___

Did you recover any money Yes /

already? No Do you still have an open
Yes /
account with the bank you
No
In case the answer is yes, ______ used?
how much? ___

Have you reported this

Have you met the
Yes / situation elsewhere? Yes /
employee of the company
No No
(suspect) face to face?
Specify:

Would you like us to report

Is the offender known to
your case on your behalf
you or known to live/work Yes / Yes /
and share your personal
close to your home or place No No
information with
of work?
competent institutions?

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Know Your Client (KYC) Form
Additional assessment:
The following questions will help us to assess your confidence in digital technologies, to better understand you as our
client and (when necessary) describe your situation to the relevant authorities. Thus, please answer as accurately as you
can.
In the following statements, 0 represents the negative extreme of not knowing, not feeling comfortable or not
understanding, whereas 10 represents the positive extreme where you express that you feel extremely comfortable,
completely understand or know precisely and in detail the subject in question. Highlight the number that better represents
your situation.

a) How confident do you feel when using a computer, cellphone, laptop or digital device?
1. Not Confident

b) How would you rate your knowledge about cryptocurrencies and their tendencies?
1. Very Poor

c) How easily do you think you can solve problems that involve software (Android, Windows, Excel,
etcetera) or electronic devices (laptops, desk computers, cellphones, etcetera)?
1. Highly unlikely

___________________________ _________________________

(Date) (Name / Signature)

Thank you for providing this information. We will contact you once we have confirmed if we can orient you.
Until then, if you have any more questions, you can call us on +36 1 408 8556.

Part 5. Event’s summary

Please elaborate a letter narrating your case and answering the questions below as accurately and precisely as
you can. Try and put the elements in the order in which they happened. We attach an example and some
questions which might be useful to guide you and important to answer in your letter.

❖ How did it start?

❖ Did you contacted the suspect company/subject or did they contacted you and how? When was
this (day/month/year)?

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Know Your Client (KYC) Form
❖ What was promised to you?

❖ What company or companies were involved? If there was more than one make sure to detail
what was each of them doing and how are they related to your case.
❖ How were you paying them? (They would send you payment links, their bank account details, a
cryptocurrency wallet…)
❖ If they used any remote application such as AnyDesk, provide us with your ID number from the
platform and the suspect/scammers as well if you have, please.
❖ Please include all individuals you had contact with and their contact details concerning the scam
company/suspect, position, why were they in contact with you…
❖ When did you realize you had fallen victim to a scam? Are you still in contact with them?

❖ If you reported this anywhere please let us know where and provide details (police report
number, bank response or outcome…)
❖ If a remote desktop application was used such as AnyDesk, please provide your ID number from
this platform, as well as those of the scammers and any code that was provided to you, the
specific dates on which this application was used…
Please prepare the letter in a separate WORD file and send it by email to your T&H Consulting Account
Manager or at info@tandhconsult.com. If you still have questions about the event’s summary letter or you are
faced with an investment scam, please contact your manager for more information.

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