Crypto Asset Recovery Form
Please provide accurate details about your crypto asset loss to help us assess your recovery case. Do not enter sensitive personal or financial information.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Crypto Asset
*
Please Select
Bitcoin (BTC)
Ethereum (ETH)
USDT (Tether)
BNB (Binance Coin)
Solana (SOL)
Other
Platform or Exchange Involved
*
Please Select
Binance
Coinbase
Kraken
KuCoin
Metamask
Trust Wallet
Other
Date of Loss or Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Approximate Amount Lost (in USD)
*
Method of Loss
*
Phishing Scam
Exchange Hack
Lost Access (e.g., password/seed phrase)
Unauthorized Transfer
Other
Last 4 Characters of Wallet Address or Transaction ID
Brief Description of the Incident
*
Actions Already Taken (if any)
Submit Recovery Request
Should be Empty: