Section 1 of 3 : Your Details

Please provide your details below. Please provide as many details as possible, especially where marked * .

Title:*
-SELECT- MrMsMissMrs
First name(s) or initials:*

Last name:*

Address:

Town:

County:

Postcode:

Your daytime telephone number
(please include the full area code):*

Email address:*

Section 2 of 3 : Trader’s Details

You may not have all the information listed below – just fill in what you can.

Name of the trader
(This could be a company name or the name of an individual):

Address:

Town:

County:

Trader’s Postcode:

Trader’s telephone number
(please include the full area code):

Trader’s website address:

Email address:

Name of trader contact person:

Section 3 of 3 : Scam Details

Type Of Scam

Advance fee
Career opportunities
Chain letters
Cheque overpayment
Clairvoyants and psychics
Holiday clubs
Investment opportunities
Landbanking
Miracle cures
Money transfer
Online dating
Pay-in-advance credit
Phishing
Premium-rate prize draws and sweepstakes
Property rentals
Pyramid selling and chain gift schemes
Racing tipsters
Shares
Slimming
Timeshare rescale
Ticketing
Used car matching
Work-from-home
Other

How did you first receive the scam?

Please select from this list and tick your answer

Post/mail
E-mail/Internet
Telephone call
Fax
SMS text
Holiday clubs
Other

Date you were first contacted
(If you are unsure of the exact date please provide as much information as possible)

Amount you were asked to pay (If applicable)

Amount actually paid (If applicable)

Method of payment (If applicable)

Cash
Cheque
Money transfer
Postal order
Bank transfer
Online payment
Other

Please provide details of the scam below:
Brief details of the scam should be limited to 2000 characters.

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